Provider Demographics
NPI:1780102756
Name:STICKLER, KAYLA MARIE
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:MARIE
Last Name:STICKLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KAYLA
Other - Middle Name:MARIE
Other - Last Name:KAPPLINGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6187 50TH AVE
Mailing Address - Street 2:
Mailing Address - City:REMUS
Mailing Address - State:MI
Mailing Address - Zip Code:49340-9768
Mailing Address - Country:US
Mailing Address - Phone:989-339-0767
Mailing Address - Fax:
Practice Address - Street 1:301 SOUTH CRAPO ST.
Practice Address - Street 2:SUITE 200
Practice Address - City:MT. PLEASANT
Practice Address - State:MI
Practice Address - Zip Code:48858
Practice Address - Country:US
Practice Address - Phone:989-772-9538
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-30
Last Update Date:2017-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011016891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty