Provider Demographics
NPI:1477023653
Name:WISNIEWSKI, KAYLE AMBER (LLMSW, CAADC)
Entity Type:Individual
Prefix:
First Name:KAYLE
Middle Name:AMBER
Last Name:WISNIEWSKI
Suffix:
Gender:F
Credentials:LLMSW, CAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1009 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48708-5705
Mailing Address - Country:US
Mailing Address - Phone:989-928-3566
Mailing Address - Fax:989-391-9596
Practice Address - Street 1:1009 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48708-5705
Practice Address - Country:US
Practice Address - Phone:989-928-3566
Practice Address - Fax:989-391-9596
Is Sole Proprietor?:No
Enumeration Date:2018-11-29
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MISA0090077101YA0400X
MI68511109601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)