KAILE VIDETICH (NPI# 1003413352) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1003413352 |
| Entity Type | Individual |
| Full Name | KAILE VIDETICH |
| Credential | LLMFT |
| Practice Address |
630 Kenmoor Ave Se Ste 103 Grand Rapids MI 49546-8626 |
| Mailing Address |
1026 Cooper Ave Se Grand Rapids MI 49507-1459 |
| Practice Telephone | 6163302330 |
| Practice Fax Number | 6166000360 |
| Enumeration Date | 2020-10-08 |
| Last Update Date | 2020-10-08 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 106H00000X | Marriage & Family Therapist | 4151001001 | MI | Behavioral Health & Social Service Providers |
| Street Address |
630 KENMOOR AVE SE STE 103 |
| City | GRAND RAPIDS |
| State | MI |
| Zip Code | 49546-8626 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770578676 | Nisha Kimberly Mckenzie | Physician Assistant | 630 Kenmoor Ave Se Ste 103, Grand Rapids, MI 49546-8626 | 2005-09-16 |
| 1629615646 | Womens Health Collective Pllc | Obstetrics & Gynecology | 630 Kenmoor Ave Se Ste 103, Grand Rapids, MI 49546-8626 | 2019-12-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437762986 | Amanda Mae Ostrom | Speech-Language Pathologist | 710 Kenmore Ave Se, #110, Grand Rapids, MI 49546 | 2020-08-25 |
| 1063075562 | Kelly Lynn Ibarra | Counselor | 4467 Cascade Road Se, Suite #4479, Grand Rapids, MI 49546 | 2019-04-19 |
| 1891257036 | Jessica Matthews LLC | Counselor | 4127 Embassy Drive Se, Grand Rapids, MI 49546 | 2019-04-05 |
| 1326518531 | Neah Morgan | Technician | 4220 Burton St Se, Grand Rapids, MI 49546 | 2018-11-29 |
| 1316430267 | Michael John Benskey | Case Manager/Care Coordinator | 4065 Saladin St Se, Grand Rapids, MI 49546 | 2018-06-14 |
| 1679062772 | Smile Cascade, P.C. | Clinic/Center | 4505 Cascade Rd Se # A, Grand Rapids, MI 49546 | 2018-05-03 |
| 1720583289 | Jeromy Krogman | Counselor | 826 Parchment Drive Se, Grand Rapids, MI 49546 | 2018-03-27 |
| 1841792660 | Affordable Hearing Clinic | Hearing Instrument Specialist | 833 Kenmoor Ave Se Ste G, Grand Rapids, MI 49546 | 2018-03-07 |
| 1689176133 | Kelly Pines | Physical Therapist | 625 Kenmoor Ave Suite 306, Grand Rapids, MI 49546 | 2018-03-01 |
| 1467971440 | Deanna Elizabeth Saenz | Social Worker | 2100 Raybrook St Se Ste 300, Grand Rapids, MI 49546 | 2017-09-12 |
| Find all providers in zip 49546 | ||||
| Taxonomy Code | 106H00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Marriage & Family Therapist |
| A marriage and family therapist is a person with a master's degree in marriage and family therapy, or a master's or doctoral degree in a related mental health field with substantially equivalent coursework in marriage and family therapy, who receives supervised clinical experience, or a person who meets the state requirements to practice as a marriage and family therapist. A marriage and family therapist treats mental and emotional disorders within the context of marriage and family systems. A marriage and family therapist provides mental health and counseling services to individuals, couples, families, and groups. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891392288 | Megan E Six | Marriage & Family Therapist | 733 Madison Ave Se, Grand Rapids, MI 49503-5317 | 2020-10-08 |
| 1649892548 | Angie L Nelson-gates | Marriage & Family Therapist | 25 Centennial Ave Nw, Grand Rapids, MI 49504-5921 | 2020-05-13 |
| 1508409715 | Susan Lesley King Roney | Marriage & Family Therapist | 934 Cambridge Dr Se, Grand Rapids, MI 49506-3360 | 2019-10-21 |
| 1730652124 | Embrace Mental Health | Marriage & Family Therapist | 504 Ne 4th Ave, Grand Rapids, MN 55744-2820 | 2019-01-08 |
| 1245787241 | Natalie Waybrant | Marriage & Family Therapist | 1971 E Beltline Ave Ne Ste 200-c, Grand Rapids, MI 49525-7045 | 2016-09-07 |
| 1578940946 | Jerry Paredes | Marriage & Family Therapist | 25 Sheldon Ave Se, Grand Rapids, MI 49503-4209 | 2015-05-05 |
| 1609086172 | Terry Ann Rosander | Marriage & Family Therapist | 1007 Parchment Dr Se, Grand Rapids, MI 49546-3664 | 2007-05-23 |
| 1720162233 | Lois J Meyer | Marriage & Family Therapist | 412 N Pokegama Ave Ste 10, Grand Rapids, MN 55744-2684 | 2006-10-24 |
| 1043315278 | Lois J Meyer | Marriage & Family Therapist | 419 Timberline Cir Sw, Grand Rapids, MN 55744 | 2006-09-13 |
| 1407872526 | Charlotte Jean Hilber | Marriage & Family Therapist | 707 E Beltline Ave Ne, Grand Rapids, MI 49525-6045 | 2006-07-14 |
| Find all providers in GRAND RAPIDS | ||||
| City | GRAND RAPIDS |
| Zip Code | 49546 |
Please comment or provide details below to improve the information on KAILE VIDETICH.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.