Provider Demographics
NPI:1295402782
Name:LINDEMULDER, KAITLIN MARIE
Entity Type:Individual
Prefix:
First Name:KAITLIN
Middle Name:MARIE
Last Name:LINDEMULDER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2911 E WATER TOWER DR
Mailing Address - Street 2:
Mailing Address - City:CRETE
Mailing Address - State:IL
Mailing Address - Zip Code:60417-4461
Mailing Address - Country:US
Mailing Address - Phone:708-351-0417
Mailing Address - Fax:
Practice Address - Street 1:2911 E WATER TOWER DR
Practice Address - Street 2:
Practice Address - City:CRETE
Practice Address - State:IL
Practice Address - Zip Code:60417-4461
Practice Address - Country:US
Practice Address - Phone:708-351-0417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-24
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA2499210103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool