Basic Information
| Provider Information | |||||||||
| NPI: | 1609277714 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KYLE | ||||||||
| FirstName: | KAITLIN | ||||||||
| MiddleName: | ELIZABETH | ||||||||
| NamePrefix: | |||||||||
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| Credential: | LPC-IT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8901 W CAPITOL DR | ||||||||
| Address2: | |||||||||
| City: | MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532221706 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4144655770 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 8901 W CAPITOL DR | ||||||||
| Address2: | |||||||||
| City: | MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532221706 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4144655770 | ||||||||
| FaxNumber: | 4144632770 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/08/2014 | ||||||||
| LastUpdateDate: | 09/26/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/26/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 7126-226 | WI | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.