Provider Demographics
NPI:1497477103
Name:OSSA, KAITLYN ELIZABETH
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:ELIZABETH
Last Name:OSSA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11677 MARKET AVE NW
Mailing Address - Street 2:
Mailing Address - City:UNIONTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44685-8599
Mailing Address - Country:US
Mailing Address - Phone:330-458-9293
Mailing Address - Fax:
Practice Address - Street 1:4680 DOUGLAS CIR NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-3619
Practice Address - Country:US
Practice Address - Phone:330-703-6578
Practice Address - Fax:330-526-6700
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-19
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health