Provider Demographics
NPI:1346969557
Name:RANGUETTE, KAILYN MCKINSEY (TLLP)
Entity type:Individual
Prefix:
First Name:KAILYN
Middle Name:MCKINSEY
Last Name:RANGUETTE
Suffix:
Gender:F
Credentials:TLLP
Other - Prefix:
Other - First Name:KAILYN
Other - Middle Name:MCKINSEY
Other - Last Name:WALES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:4690 FULTON ST E STE 102
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:MI
Mailing Address - Zip Code:49301-8454
Mailing Address - Country:US
Mailing Address - Phone:616-425-7701
Mailing Address - Fax:
Practice Address - Street 1:4690 FULTON ST E STE 102
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:MI
Practice Address - Zip Code:49301-8454
Practice Address - Country:US
Practice Address - Phone:616-425-7701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-23
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TC1900X
MI6362009536103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling