Provider Demographics
NPI:1679111983
Name:LINDSTROM, KAYLIE A (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:KAYLIE
Middle Name:A
Last Name:LINDSTROM
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MS
Other - First Name:KAYLIE
Other - Middle Name:A
Other - Last Name:LINDSTROM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:332 E 4TH ST # STY
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:14701-5502
Mailing Address - Country:US
Mailing Address - Phone:716-488-1971
Mailing Address - Fax:716-483-6878
Practice Address - Street 1:332 E 4TH ST
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:NY
Practice Address - Zip Code:14701-5502
Practice Address - Country:US
Practice Address - Phone:716-488-1971
Practice Address - Fax:716-483-6878
Is Sole Proprietor?:No
Enumeration Date:2019-12-17
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker