Provider Demographics
NPI:1306379771
Name:WOMACK, KAYCE (BSCAPPPSY)
Entity Type:Individual
Prefix:
First Name:KAYCE
Middle Name:
Last Name:WOMACK
Suffix:
Gender:F
Credentials:BSCAPPPSY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41521 W 11 MILE RD
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-1803
Mailing Address - Country:US
Mailing Address - Phone:248-299-0030
Mailing Address - Fax:
Practice Address - Street 1:8041 E BURNSIDE ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97215-1548
Practice Address - Country:US
Practice Address - Phone:503-239-8400
Practice Address - Fax:503-239-8407
Is Sole Proprietor?:No
Enumeration Date:2017-04-04
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other