MEDICARE: KAITLYN GREGOIRE LCSW

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	1041C0700X	Clinical Social Worker	34012185A	IN

General Provider Information

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

Provider Business Mailing Address
First Line	:	2440 W 39TH ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46228-3279
Country	:	US
Telephone Number	:	463-280-4941
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	:	03/03/2026

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Directions to “ KAITLYN GREGOIRE LCSW” Practice Location

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