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Individual

KAILEY NICOLE JO

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MA, CCC-SLP

Contact information

Practice address
710 KENMOOR AVE SE STE 110, GRAND RAPIDS, MI 49546-2379
(616) 591-2905
(616) 333-2321
Mailing address
5940 MILL POINT CT SE, GRAND RAPIDS, MI 49512-9363
(616) 307-3512

Taxonomy

Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
7101006090
MI

Other

Enumeration date
08/02/2020
Last updated
08/11/2020
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