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General NPI Number Information
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NPI Number | 1598413577
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Entity Type | Individual
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Provider Name | KAITLYN BREANN LALLATHIN
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Gender | Female
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Dates
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Enumeration Date | 03/17/2022
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Last Update Date | 04/29/2024
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Provider Practice Location Address
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Address Line | 122 W BROADWAY ST
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City | NEW LEXINGTON
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State | OH
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Zip | 43764-1001
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Country | US
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Telephone | 740-960-0380
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Fax |
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Provider Business Mailing Address
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Address Line | 1256 EDWARD LN APT B4
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City | ZANESVILLE
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State | OH
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Zip | 43701-2856
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Country | US
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Telephone | 740-260-7239
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 187735
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State | OH
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