Provider Demographics
NPI:1295386472
Name:VAN PAY, KAITLYN (PHD, LP)
Entity Type:Individual
Prefix:DR
First Name:KAITLYN
Middle Name:
Last Name:VAN PAY
Suffix:
Gender:F
Credentials:PHD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7245 JORDON AVE S
Mailing Address - Street 2:
Mailing Address - City:COTTAGE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55016-3655
Mailing Address - Country:US
Mailing Address - Phone:920-366-8445
Mailing Address - Fax:
Practice Address - Street 1:1303 S FRONTAGE RD STE 150
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:MN
Practice Address - Zip Code:55033-2690
Practice Address - Country:US
Practice Address - Phone:514-196-3626
Practice Address - Fax:833-597-4490
Is Sole Proprietor?:No
Enumeration Date:2019-09-27
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP6929103TC1900X
IA093352103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling