Provider Demographics
NPI:1649718966
Name:SANTHANY, KALIE
Entity type:Individual
Prefix:
First Name:KALIE
Middle Name:
Last Name:SANTHANY
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 1:7744 HERITAGE DR APT 4
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48917-6817
Mailing Address - Country:US
Mailing Address - Phone:616-283-1843
Mailing Address - Fax:
Practice Address - Street 1:7744 HERITAGE DR APT 4
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48917-6817
Practice Address - Country:US
Practice Address - Phone:616-283-1843
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-07
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI45-5476332Medicaid