Provider Demographics
NPI:1760162119
Name:KIRKHAM, KAITLYN ALISE
Entity Type:Individual
Prefix:MISS
First Name:KAITLYN
Middle Name:ALISE
Last Name:KIRKHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7340 E LEGACY BLVD UNIT H3002
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-6530
Mailing Address - Country:US
Mailing Address - Phone:801-368-6475
Mailing Address - Fax:
Practice Address - Street 1:1875 E QUEEN CREEK RD.
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297
Practice Address - Country:US
Practice Address - Phone:419-482-8382
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-20
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical