Basic Information
| Provider Information | |||||||||
| NPI: | 1861962672 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WARD | ||||||||
| FirstName: | KAITLIN | ||||||||
| MiddleName: | PAXTON | ||||||||
| NamePrefix: | |||||||||
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| Credential: | MSW, LLMSW | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | PAXTON | ||||||||
| OtherFirstName: | KAITLIN | ||||||||
| OtherMiddleName: | MICHELLE | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1785 W STADIUM BLVD STE 203C | ||||||||
| Address2: | |||||||||
| City: | ANN ARBOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481035291 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7349131093 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1785 W STADIUM BLVD STE 203C | ||||||||
| Address2: | |||||||||
| City: | ANN ARBOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481035291 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7349131093 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/05/2018 | ||||||||
| LastUpdateDate: | 12/05/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 6801103585 | MI | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.