Healthcare Provider Details

I. General information

NPI: 1780521815
Provider Name (Legal Business Name): KAITLYN STEPHENS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1695 S MAIN ST
SPRINGBORO OH
45066-1524
US

IV. Provider business mailing address

8809B CINCINNATI DAYTON RD
WEST CHESTER OH
45069-3134
US

V. Phone/Fax

Practice location:
  • Phone: 937-748-6070
  • Fax:
Mailing address:
  • Phone: 513-360-8205
  • Fax: 513-620-6545

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: