Provider Demographics
NPI:1255021655
Name:GREGOIRE, KAITLYN (LSW)
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:
Last Name:GREGOIRE
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:KAITLYN
Other - Middle Name:DIANNE
Other - Last Name:WHEAT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW
Mailing Address - Street 1:4735 STATESMEN DR STE A
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-5647
Mailing Address - Country:US
Mailing Address - Phone:317-986-4956
Mailing Address - Fax:317-452-8821
Practice Address - Street 1:4735 STATESMEN DR STE A
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250-5647
Practice Address - Country:US
Practice Address - Phone:317-986-4956
Practice Address - Fax:317-452-8821
Is Sole Proprietor?:No
Enumeration Date:2023-05-09
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN33011148A104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker