Provider Demographics
NPI:1538720677
Name:SKIFFER, KYLA NICOLE (LMSW)
Entity type:Individual
Prefix:
First Name:KYLA
Middle Name:NICOLE
Last Name:SKIFFER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:KYLA
Other - Middle Name:NICOLE
Other - Last Name:SKIFFER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMSW
Mailing Address - Street 1:24765 HANOVER ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48125-1827
Mailing Address - Country:US
Mailing Address - Phone:313-485-7927
Mailing Address - Fax:
Practice Address - Street 1:24765 HANOVER ST
Practice Address - Street 2:
Practice Address - City:DEARBORN HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48125-1827
Practice Address - Country:US
Practice Address - Phone:313-485-7927
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-27
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011051871041C0700X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty