Provider Demographics
NPI:1437813243
Name:ENDERS, KAITLYN MARIE (BS)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:MARIE
Last Name:ENDERS
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2415 24TH ST
Mailing Address - Street 2:
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-6414
Mailing Address - Country:US
Mailing Address - Phone:810-488-8840
Mailing Address - Fax:
Practice Address - Street 1:2415 24TH ST
Practice Address - Street 2:
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-6414
Practice Address - Country:US
Practice Address - Phone:810-488-8840
Practice Address - Fax:810-941-8833
Is Sole Proprietor?:No
Enumeration Date:2021-10-27
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator