Provider Demographics
NPI:1164143202
Name:AUTEN, KAITLIN M
Entity Type:Individual
Prefix:
First Name:KAITLIN
Middle Name:M
Last Name:AUTEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KAITLIN
Other - Middle Name:M
Other - Last Name:CLINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3893 KEWAUNEE RD
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54311-8264
Mailing Address - Country:US
Mailing Address - Phone:920-615-2223
Mailing Address - Fax:
Practice Address - Street 1:737 CORMIER RD
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54304-4825
Practice Address - Country:US
Practice Address - Phone:920-272-1237
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-07
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach