Provider Demographics
NPI:1386227668
Name:BLEVINS, KAITLIN PAIGE (LMSW)
Entity Type:Individual
Prefix:
First Name:KAITLIN
Middle Name:PAIGE
Last Name:BLEVINS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2990 MILITARY AVE
Mailing Address - Street 2:
Mailing Address - City:BAXTER SPRINGS
Mailing Address - State:KS
Mailing Address - Zip Code:66713-2331
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2990 MILITARY AVE
Practice Address - Street 2:
Practice Address - City:BAXTER SPRINGS
Practice Address - State:KS
Practice Address - Zip Code:66713-2331
Practice Address - Country:US
Practice Address - Phone:620-856-2900
Practice Address - Fax:620-856-2901
Is Sole Proprietor?:No
Enumeration Date:2021-05-04
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS12082104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker