Provider Demographics
NPI:1295242071
Name:SIMPSON, KAITLYN CHEYENNE
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:CHEYENNE
Last Name:SIMPSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1402 S MAGNOLIA ST
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70403-5020
Mailing Address - Country:US
Mailing Address - Phone:985-429-7611
Mailing Address - Fax:
Practice Address - Street 1:74273 HIGHWAY 1054
Practice Address - Street 2:
Practice Address - City:KENTWOOD
Practice Address - State:LA
Practice Address - Zip Code:70444-4953
Practice Address - Country:US
Practice Address - Phone:985-229-3757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-03
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
LA13680104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator