Individual
KAILE VIDETICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LLMFT
Contact information
Practice address
630 KENMOOR AVE SE STE 103, GRAND RAPIDS, MI 49546-8626
(616) 330-2330
(616) 600-0360
Mailing address
1026 COOPER AVE SE, GRAND RAPIDS, MI 49507-1459
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
4151001001
MI
Other
Enumeration date
10/08/2020
Last updated
10/08/2020
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