Provider Demographics
NPI:1841674603
Name:FERGUSON, KAYLA
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:FERGUSON
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 1:260 STEVENS DR
Mailing Address - Street 2:APT 201
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-4521
Mailing Address - Country:US
Mailing Address - Phone:734-999-6969
Mailing Address - Fax:
Practice Address - Street 1:17321 TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48219-3132
Practice Address - Country:US
Practice Address - Phone:313-504-4166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-11
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator