Provider Demographics
NPI:1215356928
Name:RUPERT, KAYTLIN ERIN (LCSW, CDC I, RPT)
Entity Type:Individual
Prefix:MRS
First Name:KAYTLIN
Middle Name:ERIN
Last Name:RUPERT
Suffix:
Gender:F
Credentials:LCSW, CDC I, RPT
Other - Prefix:MS
Other - First Name:KAYTLIN
Other - Middle Name:ERIN
Other - Last Name:CRAWFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW, CDC I, RPT
Mailing Address - Street 1:3449 E REZANOF DR
Mailing Address - Street 2:
Mailing Address - City:KODIAK
Mailing Address - State:AK
Mailing Address - Zip Code:99615-6952
Mailing Address - Country:US
Mailing Address - Phone:907-486-9800
Mailing Address - Fax:907-486-9898
Practice Address - Street 1:3449 E REZANOF DR
Practice Address - Street 2:
Practice Address - City:KODIAK
Practice Address - State:AK
Practice Address - Zip Code:99615-6952
Practice Address - Country:US
Practice Address - Phone:907-486-9800
Practice Address - Fax:907-486-9898
Is Sole Proprietor?:No
Enumeration Date:2014-04-09
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
AK1300251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker