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General NPI Number Information
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NPI Number | 1760162119
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Entity Type | Individual
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Provider Name | MISS KAITLYN ALISE KIRKHAM
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Gender | Female
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Dates
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Enumeration Date | 07/20/2023
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Last Update Date | 07/20/2023
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Provider Practice Location Address
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Address Line | 1875 E QUEEN CREEK RD.
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City | GILBERT
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State | AZ
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Zip | 85297
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Country | US
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Telephone | 419-482-8382
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Fax |
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Provider Business Mailing Address
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Address Line | 7340 E LEGACY BLVD UNIT H3002
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City | SCOTTSDALE
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State | AZ
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Zip | 85255-6530
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Country | US
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Telephone | 801-368-6475
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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