| Lifelab Kids Foundation | |
|
3178 Hilton Rd Ferndale MI 48220-1059 | |
| (248) 629-4600 | |
| (248) 331-2744 |
| Full Name | Lifelab Kids Foundation |
|---|---|
| Speciality | Behavior Analyst |
| Location | 3178 Hilton Rd, Ferndale, Michigan |
| Authorized Official Name and Position | Jai Reddy Depa (OWNER) |
| Authorized Official Contact | 2486294600 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lifelab Kids Foundation 3178 Hilton Rd Ferndale MI 48220-1059 Ph: (248) 629-4600 | Lifelab Kids Foundation 3178 Hilton Rd Ferndale MI 48220-1059 Ph: (248) 629-4600 |
| NPI Number | 1992286306 |
|---|---|
| Provider Enumeration Date | 08/23/2018 |
| Last Update Date | 03/20/2024 |
| Certification Date | 01/12/2024 |
| Medicare PECOS PAC ID | 0648519769 |
|---|---|
| Medicare Enrollment ID | O20190306002687 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992286306 | NPI | - | NPPES |
| MI17359 | Medicaid | MI |
| Provider Name | Jacqueline T Kwapisz |
|---|---|
| Provider Type | Practitioner - Qualified Speech Language Pathologist |
| Provider Identifiers | NPI Number: 1316654387 PECOS PAC ID: 4284070319 Enrollment ID: I20240312002682 |
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