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NPI Code Detail

MEDICARE: MS. KAITLIN KATHLEEN GENSLAK

MEDICARE: MS. KAITLIN KATHLEEN GENSLAK
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1104100000XSocial Worker

General Provider Information

NPI Number : 1922518133
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. KAITLIN KATHLEEN GENSLAK
Provider Business Mailing Address
First Line : 1111 40TH ST SE
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49508-6084
Country : US
Telephone Number : 616-827-4187
Fax Number :
Provider Business Practice Location Address
First Line : 1111 40TH ST SE
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49508-6084
Country : US
Telephone Number : 616-827-4187
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/03/2017
Last Update Date : 12/02/2021

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Directions to “ MS. KAITLIN KATHLEEN GENSLAK ” Practice Location

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