Basic Information
| Provider Information | |||||||||
| NPI: | 1144890948 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ASHBROOK | ||||||||
| FirstName: | KAYLIN | ||||||||
| MiddleName: | NICOLE | ||||||||
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| Credential: | LLMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 76354 S MARY GRACE CT | ||||||||
| Address2: | |||||||||
| City: | BRUCE TWP | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480652636 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8104173190 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3646 MOUNT ELLIOTT ST | ||||||||
| Address2: | |||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482072311 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3133313435 | ||||||||
| FaxNumber: | 3139240605 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/25/2021 | ||||||||
| LastUpdateDate: | 06/25/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/24/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.