Provider Demographics
NPI:1023747003
Name:DISANTI, KAITLIN A (LCSW, CADC, PEL)
Entity type:Individual
Prefix:
First Name:KAITLIN
Middle Name:A
Last Name:DISANTI
Suffix:
Gender:F
Credentials:LCSW, CADC, PEL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 N COUNTY FARM RD
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-3988
Mailing Address - Country:US
Mailing Address - Phone:630-337-5963
Mailing Address - Fax:
Practice Address - Street 1:111 N COUNTY FARM RD
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-3988
Practice Address - Country:US
Practice Address - Phone:630-337-5963
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-06
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL34741101YA0400X
IL11518881041S0200X
IL149.0245421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool