MEDICARE: KAITLIN ROLZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	1-23-69130	CO

General Provider Information

NPI Number	:	1255829438
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAITLIN ROLZ

Provider Business Mailing Address
First Line	:	1520 CHAPEL HILLS DR APT B202
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-5406
Country	:	US
Telephone Number	:	605-592-0106
Fax Number	:	605-592-0106

Provider Business Practice Location Address
First Line	:	1520 CHAPEL HILLS DR APT B202
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-5406
Country	:	US
Telephone Number	:	605-592-0106
Fax Number	:	605-592-0106

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/24/2018
Last Update Date	:	03/18/2026

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