Provider Demographics
NPI:1578288361
Name:I KALEIDOSCOPE, PLLC
Entity Type:Organization
Organization Name:I KALEIDOSCOPE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:CATHERINE
Authorized Official - Last Name:BAKHAI
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:734-881-2723
Mailing Address - Street 1:1785 W STADIUM BLVD STE 104
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-5285
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1785 W STADIUM BLVD STE 104
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-5285
Practice Address - Country:US
Practice Address - Phone:734-887-1144
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-05
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty