Provider Demographics
NPI:1932649282
Name:THAYER, KIRSTEN LOUISE (LLMSW)
Entity Type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:LOUISE
Last Name:THAYER
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4544 E LAPORTE RD
Mailing Address - Street 2:
Mailing Address - City:FREELAND
Mailing Address - State:MI
Mailing Address - Zip Code:48623-9104
Mailing Address - Country:US
Mailing Address - Phone:989-802-4422
Mailing Address - Fax:
Practice Address - Street 1:4544 E LAPORTE RD
Practice Address - Street 2:
Practice Address - City:FREELAND
Practice Address - State:MI
Practice Address - Zip Code:48623-9104
Practice Address - Country:US
Practice Address - Phone:989-802-4422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-06
Last Update Date:2024-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6802089399104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker