Provider Demographics
NPI:1013488204
Name:BAILEY, KAITLYN (CADACII)
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:
Last Name:BAILEY
Suffix:
Gender:F
Credentials:CADACII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2070 SALEM RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:RISING SUN
Mailing Address - State:IN
Mailing Address - Zip Code:47040-9435
Mailing Address - Country:US
Mailing Address - Phone:812-584-8224
Mailing Address - Fax:
Practice Address - Street 1:706 GREEN BLVD
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IN
Practice Address - Zip Code:47001-1506
Practice Address - Country:US
Practice Address - Phone:812-727-3504
Practice Address - Fax:812-727-3504
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INCII-2078101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH611530Medicaid
INCII-2078Medicaid