Provider Demographics
NPI:1861964249
Name:SEITZ, KAYLA MARIE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:KAYLA
Middle Name:MARIE
Last Name:SEITZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:522 GATEWAY AVE STE F
Mailing Address - Street 2:
Mailing Address - City:MAUSTON
Mailing Address - State:WI
Mailing Address - Zip Code:53948-1450
Mailing Address - Country:US
Mailing Address - Phone:608-285-2133
Mailing Address - Fax:608-716-3155
Practice Address - Street 1:522 GATEWAY AVE STE F
Practice Address - Street 2:
Practice Address - City:MAUSTON
Practice Address - State:WI
Practice Address - Zip Code:53948-1450
Practice Address - Country:US
Practice Address - Phone:608-285-2133
Practice Address - Fax:608-285-2133
Is Sole Proprietor?:No
Enumeration Date:2018-12-22
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1000097307Medicaid