Provider Demographics
NPI:1427565936
Name:POWELL, KAITLIN JAE
Entity Type:Individual
Prefix:MRS
First Name:KAITLIN
Middle Name:JAE
Last Name:POWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KAITLIN
Other - Middle Name:JAE
Other - Last Name:BECKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:913 W HOLMES RD STE 275
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48910-0432
Mailing Address - Country:US
Mailing Address - Phone:517-272-0520
Mailing Address - Fax:517-272-0483
Practice Address - Street 1:913 W HOLMES RD STE 275
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48910-0432
Practice Address - Country:US
Practice Address - Phone:517-272-0520
Practice Address - Fax:517-272-0483
Is Sole Proprietor?:No
Enumeration Date:2018-01-05
Last Update Date:2018-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator