Provider Demographics
NPI:1801633292
Name:KITTLES, DAEJAUN
Entity type:Individual
Prefix:
First Name:DAEJAUN
Middle Name:
Last Name:KITTLES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3716 PINOAK ST
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48348-1382
Mailing Address - Country:US
Mailing Address - Phone:248-636-7238
Mailing Address - Fax:
Practice Address - Street 1:3716 PINOAK ST
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48348-1382
Practice Address - Country:US
Practice Address - Phone:248-636-7238
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-11
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst