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General NPI Number Information
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NPI Number | 1295329027
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Entity Type | Individual
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Provider Name | KAITLYNN RENAE TREDWAY LPC, LMHC
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Gender | Female
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Dates
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Enumeration Date | 02/23/2021
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Last Update Date | 02/23/2021
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Provider Practice Location Address
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Address Line | 19472 US ROUTE 11
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City | WATERTOWN
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State | NY
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Zip | 13601-6897
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Country | US
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Telephone | 315-802-3262
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 50
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City | DEXTER
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State | NY
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Zip | 13634-0050
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Country | US
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Telephone | 269-967-1709
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 004114
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 010123-01
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License Number State | NY
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