MEDICARE: KAITLYN GREGOIRE LSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	33011148A	IN

General Provider Information

NPI Number	:	1255021655
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAITLYN GREGOIRE LSW

Provider Business Mailing Address
First Line	:	2440 W 39TH ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46228-3279
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2440 W 39TH ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46228-3279
Country	:	US
Telephone Number	:	317-289-7470
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/09/2023
Last Update Date	:	07/09/2025

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Directions to “ KAITLYN GREGOIRE LSW” Practice Location

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