Most Relevant Information
Provider Data
| NPI Number: | 1003413352 |
| Provider Name: | KAILE VIDETICH LLMFT |
| Entity Type: | Individual |
| Taxonomy Code: | 106H00000X |
| Specialty: | Marriage & Family Therapist |
| License Number: | 4151001001 |
Most Important Dates
| Enumeration Date: | 10/08/2020 |
| Last Updated: | 10/08/2020 |
Provider Practice Location
630 KENMOOR AVE SE STE 103
GRAND RAPIDS
MI
495468626
Practice Location Phone/Fax
| Phone: | 6163302330 |
| Fax: | 6166000360 |
Provider Mailing Location
1026 COOPER AVE SE
GRAND RAPIDS
MI
495071459
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |