Provider Demographics
NPI:1629754288
Name:FORTNA, KAILIN (LSW)
Entity Type:Individual
Prefix:
First Name:KAILIN
Middle Name:
Last Name:FORTNA
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 DREW CT
Mailing Address - Street 2:
Mailing Address - City:BIRDSBORO
Mailing Address - State:PA
Mailing Address - Zip Code:19508-2500
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:333 DREW CT
Practice Address - Street 2:
Practice Address - City:BIRDSBORO
Practice Address - State:PA
Practice Address - Zip Code:19508-2500
Practice Address - Country:US
Practice Address - Phone:610-764-3919
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-27
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW132290104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker