Provider Demographics
NPI:1871003780
Name:WEBB, KADIE CONSTANCE
Entity Type:Individual
Prefix:
First Name:KADIE
Middle Name:CONSTANCE
Last Name:WEBB
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29045 VAN RIPER ST
Mailing Address - Street 2:
Mailing Address - City:FLAT ROCK
Mailing Address - State:MI
Mailing Address - Zip Code:48134-1228
Mailing Address - Country:US
Mailing Address - Phone:734-771-9612
Mailing Address - Fax:
Practice Address - Street 1:29045 VAN RIPER ST
Practice Address - Street 2:
Practice Address - City:FLAT ROCK
Practice Address - State:MI
Practice Address - Zip Code:48134-1228
Practice Address - Country:US
Practice Address - Phone:734-771-9612
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-05
Last Update Date:2017-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker