Provider Demographics
NPI:1568992956
Name:FETTER, KAITLYN AMANDA (LLBSW)
Entity Type:Individual
Prefix:MRS
First Name:KAITLYN
Middle Name:AMANDA
Last Name:FETTER
Suffix:
Gender:F
Credentials:LLBSW
Other - Prefix:MS
Other - First Name:KAITLYN
Other - Middle Name:AMANDA
Other - Last Name:DOWNING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:30980 WESTGATE BLVD.
Mailing Address - Street 2:APT. 56
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48377
Mailing Address - Country:US
Mailing Address - Phone:810-597-7500
Mailing Address - Fax:
Practice Address - Street 1:30980 WESTGATE BLVD.
Practice Address - Street 2:APT. 56
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48377
Practice Address - Country:US
Practice Address - Phone:810-597-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-18
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIC-04077101YA0400X
MI6802088649104100000X
MI68011083751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker