MEDICARE: KAITLYN GARTNER

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	104100000X	Social Worker

General Provider Information

NPI Number	:	1477234672
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAITLYN GARTNER

Provider Business Mailing Address
First Line	:	2208 HAYES ST NE
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55418-3933
Country	:	US
Telephone Number	:	612-968-5107
Fax Number	:

Provider Business Practice Location Address
First Line	:	2125 E HENNEPIN AVE STE 100
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55413-1763
Country	:	US
Telephone Number	:	651-313-8080
Fax Number	:

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

Provider Enumeration Date	:	07/31/2023
Last Update Date	:	07/31/2023

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Directions to “ KAITLYN GARTNER ” Practice Location

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