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General NPI Number Information
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NPI Number | 1669124491
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Entity Type | Organization
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Legal Business Name | KAITLYN WHITEBREAD LCPC PLLC
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Dates
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Enumeration Date | 01/24/2022
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Last Update Date | 01/24/2022
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Provider Practice Location Address
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Address Line | 1818 DEMPSTER ST
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City | EVANSTON
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State | IL
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Zip | 60202-1003
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Country | US
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Telephone | 440-567-1044
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Fax |
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Provider Business Mailing Address
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Address Line | 726 HINMAN AVE APT 2E
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City | EVANSTON
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State | IL
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Zip | 60202-2570
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Country | US
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Telephone | 440-567-1044
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Fax |
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Authorized Official
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Title or Position | OWNER/PSYCHOTHERAPIST
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Name | KAITLYN WHITEBREAD
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Credential | LCPC
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Telephone | 440-567-1044
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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 |
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License Number State |
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