Provider Demographics
NPI:1558858431
Name:BAXTER, KAYLA RAE (LICSW)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:RAE
Last Name:BAXTER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 E SARNIA ST
Mailing Address - Street 2:
Mailing Address - City:WINONA
Mailing Address - State:MN
Mailing Address - Zip Code:55987-6365
Mailing Address - Country:US
Mailing Address - Phone:507-454-4341
Mailing Address - Fax:507-205-4296
Practice Address - Street 1:420 E SARNIA ST
Practice Address - Street 2:
Practice Address - City:WINONA
Practice Address - State:MN
Practice Address - Zip Code:55987-6365
Practice Address - Country:US
Practice Address - Phone:507-454-4341
Practice Address - Fax:507-453-6267
Is Sole Proprietor?:No
Enumeration Date:2018-04-17
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN230641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical