Healthcare Provider Details

I. General information

NPI: 1285553560
Provider Name (Legal Business Name): KAITLYN MURDOCH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37331 BERKSHIRE DR
MADERA CA
93636-8527
US

IV. Provider business mailing address

37331 BERKSHIRE DR
MADERA CA
93636-8527
US

V. Phone/Fax

Practice location:
  • Phone: 559-916-4195
  • Fax:
Mailing address:
  • Phone: 559-916-4195
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW.09932162
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: