Most Relevant Information
Provider Data
| NPI Number: | 1003505793 |
| Provider Name: | KAYLA D CANNON |
| Entity Type: | Individual |
| Taxonomy Code: | 175T00000X |
| Specialty: | Peer Specialist |
| License Number: |
Most Important Dates
| Enumeration Date: | 05/08/2023 |
| Last Updated: | 05/08/2023 |
Provider Practice Location
7310 WOODWARD AVE STE 600
DETROIT
MI
482023165
Practice Location Phone/Fax
| Phone: | 3138961444 |
| Fax: |
Provider Mailing Location
18460 KELLY RD
DETROIT
MI
482241024
Provider Mailing Phone/Fax
| Phone: | 3137368188 |
| Fax: |