Healthcare Provider Details

I. General information

NPI: 1669317665
Provider Name (Legal Business Name): KAYTLIN ANN NELSON PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2026
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 ELAINE DR
LUDLOW MA
01056-1258
US

IV. Provider business mailing address

32 ELAINE DR
LUDLOW MA
01056-1258
US

V. Phone/Fax

Practice location:
  • Phone: 413-519-8762
  • Fax:
Mailing address:
  • Phone: 413-519-8762
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number58493650
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: