Provider Demographics
NPI:1518714146
Name:RIVERS, KAITLYNN
Entity type:Individual
Prefix:
First Name:KAITLYNN
Middle Name:
Last Name:RIVERS
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 1:6936 PINE ARBOR DR S STE 200
Mailing Address - Street 2:
Mailing Address - City:COTTAGE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55016-4672
Mailing Address - Country:US
Mailing Address - Phone:651-461-2903
Mailing Address - Fax:651-461-2904
Practice Address - Street 1:6936 PINE ARBOR DR S STE 200
Practice Address - Street 2:
Practice Address - City:COTTAGE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55016-4672
Practice Address - Country:US
Practice Address - Phone:651-461-2903
Practice Address - Fax:651-461-2904
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-01
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional