Provider Demographics
NPI:1902482698
Name:BROOKS, KAITLYN COLLEEN (BEHAVIOR TECHNICIAN)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:COLLEEN
Last Name:BROOKS
Suffix:
Gender:F
Credentials:BEHAVIOR TECHNICIAN
Other - Prefix:
Other - First Name:KAITLYN
Other - Middle Name:COLLEEN
Other - Last Name:BROOKS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:KAITLYN BROOKS
Mailing Address - Street 1:7572 CROSSCREEK DR
Mailing Address - Street 2:
Mailing Address - City:TEMPERANCE
Mailing Address - State:MI
Mailing Address - Zip Code:48182-9270
Mailing Address - Country:US
Mailing Address - Phone:734-322-7768
Mailing Address - Fax:
Practice Address - Street 1:1349 S HURON ST
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-7021
Practice Address - Country:US
Practice Address - Phone:734-929-2620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-22
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician