Healthcare Provider Details

I. General information

NPI: 1811487986
Provider Name (Legal Business Name): KAITLYN M GROTE LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2018
Last Update Date: 01/11/2022
Certification Date: 01/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4790 RED BANK RD STE 128
CINCINNATI OH
45227-1509
US

IV. Provider business mailing address

4790 RED BANK RD STE 128
CINCINNATI OH
45227-1509
US

V. Phone/Fax

Practice location:
  • Phone: 513-731-3346
  • Fax:
Mailing address:
  • Phone: 513-731-3346
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.2102555
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberC.1800956-TRNE
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: