Healthcare Provider Details

I. General information

NPI: 1356839914
Provider Name (Legal Business Name): KAITLIN MARIE CARTER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2018
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

618 WASHINGTON ST
PELLA IA
50219-1539
US

IV. Provider business mailing address

618 WASHINGTON ST
PELLA IA
50219-1539
US

V. Phone/Fax

Practice location:
  • Phone: 641-448-6506
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number090633
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: