Healthcare Provider Details

I. General information

NPI: 1962147785
Provider Name (Legal Business Name): KAITLYN MARIE VAJGRT LADC, LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAITLYN MARIE ROBERTS LADC, LSW

II. Dates (important events)

Enumeration Date: 05/05/2022
Last Update Date: 03/28/2025
Certification Date: 03/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 ROUNDWIND RD
LUVERNE MN
56156-1300
US

IV. Provider business mailing address

512 S DONALDSON ST
LUVERNE MN
56156-2203
US

V. Phone/Fax

Practice location:
  • Phone: 507-920-4592
  • Fax:
Mailing address:
  • Phone: 507-220-1146
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number306313
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: