Most Relevant Information
Provider Data
| NPI Number: | 1003586868 |
| Provider Name: | KYLIE ELLSWORTH |
| Entity Type: | Individual |
| Taxonomy Code: | 104100000X |
| Specialty: | Social Worker |
| License Number: |
Most Important Dates
| Enumeration Date: | 09/14/2021 |
| Last Updated: | 09/14/2021 |
Provider Practice Location
1206 CLINTON RD
JACKSON
MI
492022005
Practice Location Phone/Fax
| Phone: | 5177834250 |
| Fax: | 5177834164 |
Provider Mailing Location
1206 CLINTON RD
JACKSON
MI
492022005
Provider Mailing Phone/Fax
| Phone: | 5172478859 |
| Fax: | 5177834164 |