Provider Demographics
NPI:1679042352
Name:MAGUIRE, KAITLIN (MA)
Entity Type:Individual
Prefix:
First Name:KAITLIN
Middle Name:
Last Name:MAGUIRE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11386 MT ANGEL HTS
Mailing Address - Street 2:
Mailing Address - City:PEYTON
Mailing Address - State:CO
Mailing Address - Zip Code:80831-8643
Mailing Address - Country:US
Mailing Address - Phone:719-213-7983
Mailing Address - Fax:
Practice Address - Street 1:119 N WAHSATCH AVE
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-3406
Practice Address - Country:US
Practice Address - Phone:719-578-5433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-25
Last Update Date:2018-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0015669101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health