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NPI Code Detail

MEDICARE: KAITLYN UNDERWOOD LCSW

MEDICARE: KAITLYN UNDERWOOD 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
11041C0700XClinical Social WorkerBBH-LCSW-LIC-70503MT

General Provider Information

NPI Number : 1528725512
Entity Type Code : Individual
Provider Name (Legal Business Name) : KAITLYN UNDERWOOD LCSW
Provider Business Mailing Address
First Line : 2620 CONNERY WAY
Second Line :
City : MISSOULA
State : MT
Zip : 59808-1325
Country : US
Telephone Number : 406-599-4205
Fax Number :
Provider Business Practice Location Address
First Line : 2620 CONNERY WAY
Second Line :
City : MISSOULA
State : MT
Zip : 59808-1325
Country : US
Telephone Number : 406-203-9948
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/24/2021
Last Update Date : 09/29/2025

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