Kaile Videtich, LLMFT

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

4151001001 Issued in MI

Practice address

630 Kenmoor Ave SE Ste 103
Grand Rapids, MI 49546-8626

Phone

(616) 330-2330

Fax

(616) 600-0360

NPI assigned

Oct 8, 2020

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/20679/brand/1/csg/1/fhir/r4

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1602115200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1602115200000",
    "number": "1003413352",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1026 COOPER AVE SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495071459"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "630 KENMOOR AVE SE STE 103",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495468626",
            "telephone_number": "616-330-2330",
            "fax_number": "616-600-0360"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VIDETICH",
        "first_name": "KAILE",
        "credential": "LLMFT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-10-08",
        "last_updated": "2020-10-08",
        "certification_date": "2020-10-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "MI",
            "license": "4151001001",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Justin Nicholas Victor, PT, DPT
• Diana Victorino-Tellez
• Victory Palace
• Ann Elisabeth Victory, MD
• Vida Wellness
• Boris Vidri, M.D.
• Emily Rose Vidri
• Nicholas Vieau
• Connor Chambon Vieck, PA-C
• Simone Alejandra Vieco, LMSW

• Marriage & Family Therapist in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Marriage & Family Therapist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.