Provider Demographics
NPI:1902403942
Name:PIJANOWSKI, KAITLYN (MA)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:
Last Name:PIJANOWSKI
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 1:11 S 12TH ST APT 102
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55403-2029
Mailing Address - Country:US
Mailing Address - Phone:630-699-4610
Mailing Address - Fax:
Practice Address - Street 1:445 BROADWAY AVE STE A
Practice Address - Street 2:
Practice Address - City:ST PAUL PARK
Practice Address - State:MN
Practice Address - Zip Code:55071-1554
Practice Address - Country:US
Practice Address - Phone:630-699-4610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-02
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty