Provider Demographics
NPI:1689461709
Name:HODGES, KAITLYN COURTNEY
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:COURTNEY
Last Name:HODGES
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1710 DOUGLAS DR N STE 225V
Mailing Address - Street 2:
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55422-4366
Mailing Address - Country:US
Mailing Address - Phone:952-900-2344
Mailing Address - Fax:952-443-8616
Practice Address - Street 1:1710 DOUGLAS DR N STE 225V
Practice Address - Street 2:
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55422-4366
Practice Address - Country:US
Practice Address - Phone:952-900-2344
Practice Address - Fax:952-443-8616
Is Sole Proprietor?:No
Enumeration Date:2025-04-22
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician