Provider Demographics
NPI:1912366287
Name:LEES, KAITLYN D (LSW)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:D
Last Name:LEES
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 39
Mailing Address - Street 2:18 2ND AVE SE
Mailing Address - City:STANLEY
Mailing Address - State:ND
Mailing Address - Zip Code:58784-0039
Mailing Address - Country:US
Mailing Address - Phone:701-628-2925
Mailing Address - Fax:701-628-3175
Practice Address - Street 1:18 2ND AVE SE
Practice Address - Street 2:
Practice Address - City:STANLEY
Practice Address - State:ND
Practice Address - Zip Code:58784-0039
Practice Address - Country:US
Practice Address - Phone:701-628-2925
Practice Address - Fax:701-628-3175
Is Sole Proprietor?:No
Enumeration Date:2016-02-16
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND5149OtherSW LICENSE