MEDICARE: KAYLYN AHRENDT LICSW

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	1041C0700X	Clinical Social Worker	22802	MN

General Provider Information

NPI Number	:	1386200434
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAYLYN AHRENDT LICSW

Provider Business Mailing Address
First Line	:	PO BOX 54
Second Line	:
City	:	EAGLE BEND
State	:	MN
Zip	:	56446-0054
Country	:	US
Telephone Number	:	320-219-1689
Fax Number	:

Provider Business Practice Location Address
First Line	:	305 30TH AVE W
Second Line	:
City	:	ALEXANDRIA
State	:	MN
Zip	:	56308-3429
Country	:	US
Telephone Number	:	320-460-8028
Fax Number	:

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

Provider Enumeration Date	:	05/14/2019
Last Update Date	:	05/04/2023

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