Provider Demographics
NPI:1720963226
Name:YAKLIN, KENNETH JAMES
Entity type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:JAMES
Last Name:YAKLIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 W OLIVER ST
Mailing Address - Street 2:
Mailing Address - City:OWOSSO
Mailing Address - State:MI
Mailing Address - Zip Code:48867-2251
Mailing Address - Country:US
Mailing Address - Phone:231-884-1064
Mailing Address - Fax:
Practice Address - Street 1:421 W OLIVER ST
Practice Address - Street 2:
Practice Address - City:OWOSSO
Practice Address - State:MI
Practice Address - Zip Code:48867-2251
Practice Address - Country:US
Practice Address - Phone:231-884-1064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-06
Last Update Date:2025-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI47042804374163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health