Provider Demographics
NPI:1649862921
Name:SWITALSKI, KAITLYN ROSE
Entity type:Individual
Prefix:MISS
First Name:KAITLYN
Middle Name:ROSE
Last Name:SWITALSKI
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 1:56 DURAND CT
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48602-5414
Mailing Address - Country:US
Mailing Address - Phone:989-414-0728
Mailing Address - Fax:
Practice Address - Street 1:56 DURAND CT
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48602-5414
Practice Address - Country:US
Practice Address - Phone:989-414-0728
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-08
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIS342461744437106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI001020712OtherAETNA