Provider Demographics
NPI:1447727698
Name:STANDIFORD, KAILYN
Entity type:Individual
Prefix:
First Name:KAILYN
Middle Name:
Last Name:STANDIFORD
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 1:6900 YOUNG AVE NE
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:MI
Mailing Address - Zip Code:49341-9414
Mailing Address - Country:US
Mailing Address - Phone:714-321-9987
Mailing Address - Fax:
Practice Address - Street 1:6900 YOUNG AVE NE
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:MI
Practice Address - Zip Code:49341-9414
Practice Address - Country:US
Practice Address - Phone:714-321-9987
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-25
Last Update Date:2018-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other