Kayla Marie Wilderman, LMSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

6801103361 Issued in MI

Practice address

1505 Waterford Pkwy
Saint Johns, MI 48879-9630

Phone

(989) 350-9453

NPI assigned

Jan 14, 2019

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)

Enrolled

State licenses

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

{
    "created_epoch": "1547424000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726704000000",
    "number": "1700350774",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1505 WATERFORD PKWY",
            "city": "SAINT JOHNS",
            "state": "MI",
            "postal_code": "488799630",
            "telephone_number": "989-350-9453"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1505 WATERFORD PKWY",
            "city": "SAINT JOHNS",
            "state": "MI",
            "postal_code": "488799630",
            "telephone_number": "989-350-9453"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2782 S Otsego Ave",
            "address_purpose": "LOCATION",
            "city": "Gaylord",
            "state": "MI",
            "postal_code": "497359404",
            "country_code": "US",
            "telephone_number": "989-732-7525",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILDERMAN",
        "first_name": "KAYLA",
        "middle_name": "MARIE",
        "credential": "LMSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-01-14",
        "last_updated": "2024-09-19",
        "certification_date": "2024-09-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "6801103361",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Renae Janell Wellman
• Mark S White, OD
• Noah White, PA
• Nina Lynn Whitehill, M.A., L.P.C.
• Wilder Counseling Services LLC
• Andrea L Williams, R.D.
• Amy Jo Wilson, LPN
• Shannon Lyn Wirth, RPH
• Tracy Marie Wirth, F.N.P.
• Katie Jo Wohlfert

• Clinical Social Worker in Saint Johns, MI
• Providers in Saint Johns, MI by specialty
• Clinical Social Worker in Michigan

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