Hannah Kingkittisack, LBA, TLLP

Primary specialty

Clinical Child & Adolescent PsychologistTaxonomy code 103TC2200X

License

6362010066 Issued in MI

Practice address

16500 Tireman St
Detroit, MI 48228-3629

Phone

(313) 451-1390

NPI assigned

May 8, 2018

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Hannah Riesser Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1525737600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731974400000",
    "number": "1669961363",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2675 FINI DR",
            "city": "MILFORD",
            "state": "MI",
            "postal_code": "483803960",
            "telephone_number": "810-599-0396"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16500 TIREMAN ST",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482283629",
            "telephone_number": "313-451-1390"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10031 Spencer Rd",
            "address_purpose": "LOCATION",
            "city": "Brighton",
            "state": "MI",
            "postal_code": "481143806",
            "country_code": "US",
            "telephone_number": "810-229-4334",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KINGKITTISACK",
        "first_name": "HANNAH",
        "credential": "LBA, TLLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-05-08",
        "last_updated": "2024-11-19",
        "certification_date": "2024-11-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "MI",
            "license": "6362010066",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "HANNAH",
            "last_name": "RIESSER",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Ryan King
• Sarietha King
• Senora King
• Tawanna Q King
• Touria King
• Kings Kids Child Care LLC
• Kings Special Care Home Inc
• Amber Kingsley, LLMSW
• Kristen Kingzett, MD
• Sudha R. Kini, M.D.

• Clinical Child & Adolescent Psychologist in Detroit, MI
• Providers in Detroit, MI by specialty
• Clinical Child & Adolescent Psychologist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2024; 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.