Provider Demographics
NPI:1952816258
Name:HIRTH, KAITLIN FORTH (MSW, LISW-S)
Entity Type:Individual
Prefix:
First Name:KAITLIN
Middle Name:FORTH
Last Name:HIRTH
Suffix:
Gender:F
Credentials:MSW, LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21740 DEAL RD
Mailing Address - Street 2:
Mailing Address - City:GAMBIER
Mailing Address - State:OH
Mailing Address - Zip Code:43022-9739
Mailing Address - Country:US
Mailing Address - Phone:740-322-3652
Mailing Address - Fax:
Practice Address - Street 1:21740 DEAL RD
Practice Address - Street 2:
Practice Address - City:GAMBIER
Practice Address - State:OH
Practice Address - Zip Code:43022-9739
Practice Address - Country:US
Practice Address - Phone:740-322-3652
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-08
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALICSW1275481041C0700X
OHI.2204086-SUPV1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical