Healthcare Provider Details

I. General information

NPI: 1982533097
Provider Name (Legal Business Name): KAITLIN MATHEWS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2026
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 W WATER ST
TROY OH
45373-3293
US

IV. Provider business mailing address

203 PERRINE ST
DAYTON OH
45410-1311
US

V. Phone/Fax

Practice location:
  • Phone: 937-949-0121
  • Fax:
Mailing address:
  • Phone: 614-395-1538
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC.2607920
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: