Provider Demographics
NPI:1336822394
Name:CONNELL, KAITLYN DANIELLE
Entity Type:Individual
Prefix:
First Name:KAITLYN
Middle Name:DANIELLE
Last Name:CONNELL
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 1:2407 PLANTATION CENTER DR
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-5418
Mailing Address - Country:US
Mailing Address - Phone:704-993-1856
Mailing Address - Fax:
Practice Address - Street 1:2407 PLANTATION CENTER DR
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-5418
Practice Address - Country:US
Practice Address - Phone:704-993-1856
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-08
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician