Provider Demographics
NPI:1891258869
Name:EISENHAUER, KAITLIN L
Entity Type:Individual
Prefix:
First Name:KAITLIN
Middle Name:L
Last Name:EISENHAUER
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 1:15 S 9TH ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:17042-5104
Mailing Address - Country:US
Mailing Address - Phone:717-273-5992
Mailing Address - Fax:717-775-3443
Practice Address - Street 1:15 S 9TH ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17042-5104
Practice Address - Country:US
Practice Address - Phone:717-273-5992
Practice Address - Fax:717-775-3443
Is Sole Proprietor?:No
Enumeration Date:2019-04-08
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA1-21-48777103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst