Healthcare Provider Details

I. General information

NPI: 1538609813
Provider Name (Legal Business Name): KAITLYN KROHN LPCIT, SACIT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAITLYN MULTHAUF

II. Dates (important events)

Enumeration Date: 03/06/2017
Last Update Date: 10/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 N LYNNDALE DR C
APPLETON WI
54914-3056
US

IV. Provider business mailing address

1000 N LYNNDALE DR C
APPLETON WI
54914-3056
US

V. Phone/Fax

Practice location:
  • Phone: 920-735-9010
  • Fax: 920-735-9050
Mailing address:
  • Phone: 920-735-9010
  • Fax: 920-735-9050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number3096-226
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: