Provider Demographics
NPI:1134212350
Name:CONRAD, KAYLA JAN (PHD LMSW)
Entity type:Individual
Prefix:DR
First Name:KAYLA
Middle Name:JAN
Last Name:CONRAD
Suffix:
Gender:F
Credentials:PHD LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1214 BIRK AVE
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-5306
Mailing Address - Country:US
Mailing Address - Phone:248-229-2123
Mailing Address - Fax:734-845-3235
Practice Address - Street 1:2215 FULLER RD # 116A
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48105-2303
Practice Address - Country:US
Practice Address - Phone:248-646-6659
Practice Address - Fax:248-642-8645
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MIL973160103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical