Provider Demographics
NPI:1841764859
Name:CUMMINGS, KAITLYN J
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:J
Last Name:CUMMINGS
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 1:23 S BEECH ST # B102
Mailing Address - Street 2:
Mailing Address - City:CORTEZ
Mailing Address - State:CO
Mailing Address - Zip Code:81321-3751
Mailing Address - Country:US
Mailing Address - Phone:970-946-1539
Mailing Address - Fax:
Practice Address - Street 1:23 S BEECH ST # B102
Practice Address - Street 2:
Practice Address - City:CORTEZ
Practice Address - State:CO
Practice Address - Zip Code:81321-3751
Practice Address - Country:US
Practice Address - Phone:970-946-1539
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-14
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1-19-37747103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst