Provider Demographics
NPI:1699379156
Name:KUSNIER, KYLE JOSEPH
Entity Type:Individual
Prefix:MR
First Name:KYLE
Middle Name:JOSEPH
Last Name:KUSNIER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9844 HORSESHOE BND
Mailing Address - Street 2:
Mailing Address - City:DEXTER
Mailing Address - State:MI
Mailing Address - Zip Code:48130-9535
Mailing Address - Country:US
Mailing Address - Phone:734-417-2806
Mailing Address - Fax:
Practice Address - Street 1:9844 HORSESHOE BND
Practice Address - Street 2:
Practice Address - City:DEXTER
Practice Address - State:MI
Practice Address - Zip Code:48130-9535
Practice Address - Country:US
Practice Address - Phone:734-417-2806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-25
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician