Provider Demographics
NPI:1861962672
Name:WARD, KAITLIN PAXTON (PHD, LCSW)
Entity type:Individual
Prefix:DR
First Name:KAITLIN
Middle Name:PAXTON
Last Name:WARD
Suffix:
Gender:F
Credentials:PHD, LCSW
Other - Prefix:
Other - First Name:KAITLIN
Other - Middle Name:MICHELLE
Other - Last Name:PAXTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1785 W STADIUM BLVD STE 203C
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-5291
Mailing Address - Country:US
Mailing Address - Phone:734-913-1093
Mailing Address - Fax:
Practice Address - Street 1:1785 W STADIUM BLVD STE 203C
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-5291
Practice Address - Country:US
Practice Address - Phone:734-913-1093
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-05
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801103585104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker