Basic Information
| Provider Information | |||||||||
| NPI: | 1679096887 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HARDIN | ||||||||
| FirstName: | KAITLIN | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | APSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 25 KESSEL CT STE 105 | ||||||||
| Address2: | |||||||||
| City: | MADISON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 537116227 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 702 W MAIN ST | ||||||||
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| City: | MADISON | ||||||||
| State: | WI | ||||||||
| PostalCode: | 537151424 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6082802700 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/19/2017 | ||||||||
| LastUpdateDate: | 07/19/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 130517 | WI | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.