Provider Demographics
NPI:1508230947
Name:LEE, KAITLYN ANNE (BS, MSW)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:ANNE
Last Name:LEE
Suffix:
Gender:F
Credentials:BS, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5915 S HOLLY RD
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99224-9469
Mailing Address - Country:US
Mailing Address - Phone:095-768-6852
Mailing Address - Fax:
Practice Address - Street 1:5915 S HOLLY RD
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99224-9469
Practice Address - Country:US
Practice Address - Phone:095-768-6852
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-23
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 171M00000X
WASC610632061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator