Provider Demographics
NPI:1184286965
Name:TOBELER, KAITLYN MARIE (LLBSW QIDP)
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:MARIE
Last Name:TOBELER
Suffix:
Gender:F
Credentials:LLBSW QIDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7178 LAKE VISTA DR SW APT 3A
Mailing Address - Street 2:
Mailing Address - City:BYRON CENTER
Mailing Address - State:MI
Mailing Address - Zip Code:49315-9038
Mailing Address - Country:US
Mailing Address - Phone:734-383-5069
Mailing Address - Fax:
Practice Address - Street 1:7178 LAKE VISTA DR SW APT 3A
Practice Address - Street 2:
Practice Address - City:BYRON CENTER
Practice Address - State:MI
Practice Address - Zip Code:49315-9038
Practice Address - Country:US
Practice Address - Phone:734-383-5069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-02
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6802090066104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker