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General NPI Number Information
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NPI Number | 1902433493
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Entity Type | Individual
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Provider Name | KAITLYN MAE HALLWYLER LBSW
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Gender | Female
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Dates
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Enumeration Date | 03/24/2020
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Last Update Date | 03/24/2020
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Provider Practice Location Address
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Address Line | 2884 N ROADRUNNER PKWY
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City | LAS CRUCES
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State | NM
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Zip | 88011-0853
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Country | US
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Telephone | 575-556-6115
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Fax |
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Provider Business Mailing Address
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Address Line | 906 S MELENDRES ST
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City | LAS CRUCES
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State | NM
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Zip | 88005-2932
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Country | US
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Telephone | 313-405-8915
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | X-11430
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License Number State | NM
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