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NPI Code Detail

MEDICARE: KAITLYN DION ELAM

MEDICARE: KAITLYN DION ELAM
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
1101YA0400XAddiction (Substance Use Disorder) CounselorR1615540525CA

General Provider Information

NPI Number : 1902620339
Entity Type Code : Individual
Provider Name (Legal Business Name) : KAITLYN DION ELAM
Provider Business Mailing Address
First Line : 1143 MISSOURI ST
Second Line :
City : FAIRFIELD
State : CA
Zip : 94533-6007
Country : US
Telephone Number : 707-435-9911
Fax Number : 707-435-0704
Provider Business Practice Location Address
First Line : 1143 MISSOURI ST
Second Line :
City : FAIRFIELD
State : CA
Zip : 94533-6007
Country : US
Telephone Number : 707-435-9911
Fax Number : 707-435-0704
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/12/2024
Last Update Date : 02/18/2026

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Directions to “ KAITLYN DION ELAM ” Practice Location

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