Basic Information
| Provider Information | |||||||||
| NPI: | 1821717331 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCNEILL | ||||||||
| FirstName: | KIERA | ||||||||
| MiddleName: | LYN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4044 STONEY CREEK DR | ||||||||
| Address2: | |||||||||
| City: | FORT GRATIOT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480593738 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4847921974 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3111 ELECTRIC AVE | ||||||||
| Address2: | |||||||||
| City: | PORT HURON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480608127 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8109858900 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/26/2022 | ||||||||
| LastUpdateDate: | 08/26/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/26/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | MI | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.