Provider Demographics
NPI:1033873567
Name:RODELL, KAITLIN (MPH)
Entity Type:Individual
Prefix:
First Name:KAITLIN
Middle Name:
Last Name:RODELL
Suffix:
Gender:F
Credentials:MPH
Other - Prefix:
Other - First Name:KAITLIN
Other - Middle Name:
Other - Last Name:DRUFFEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPH
Mailing Address - Street 1:55 E MARYANNA LN
Mailing Address - Street 2:
Mailing Address - City:HAYDEN
Mailing Address - State:ID
Mailing Address - Zip Code:83835-5162
Mailing Address - Country:US
Mailing Address - Phone:509-595-0850
Mailing Address - Fax:
Practice Address - Street 1:55 E MARYANNA LN
Practice Address - Street 2:
Practice Address - City:HAYDEN
Practice Address - State:ID
Practice Address - Zip Code:83835-5162
Practice Address - Country:US
Practice Address - Phone:509-595-0850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-31
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician