Provider Demographics
NPI:1386161693
Name:PEFFERS, KAYLEIGH JEAN
Entity type:Individual
Prefix:
First Name:KAYLEIGH
Middle Name:JEAN
Last Name:PEFFERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20151 GILBERT RD APT F1
Mailing Address - Street 2:
Mailing Address - City:BIG RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49307-2322
Mailing Address - Country:US
Mailing Address - Phone:616-690-5523
Mailing Address - Fax:
Practice Address - Street 1:222 E 82ND ST
Practice Address - Street 2:
Practice Address - City:NEWAYGO
Practice Address - State:MI
Practice Address - Zip Code:49337-8890
Practice Address - Country:US
Practice Address - Phone:231-652-1780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-28
Last Update Date:2017-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical