Provider Demographics
NPI:1265175228
Name:AUBIN, KAITLIN (CIMHP, LCSW)
Entity type:Individual
Prefix:
First Name:KAITLIN
Middle Name:
Last Name:AUBIN
Suffix:
Gender:F
Credentials:CIMHP, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1613 ERIN DR
Mailing Address - Street 2:
Mailing Address - City:NORMAL
Mailing Address - State:IL
Mailing Address - Zip Code:61761-4317
Mailing Address - Country:US
Mailing Address - Phone:309-262-4773
Mailing Address - Fax:
Practice Address - Street 1:1613 ERIN DR
Practice Address - Street 2:
Practice Address - City:NORMAL
Practice Address - State:IL
Practice Address - Zip Code:61761-4317
Practice Address - Country:US
Practice Address - Phone:309-262-4773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-18
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0235781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical