Provider Demographics
NPI:1356890263
Name:ANDERSON, KAITLYN (MA, LPC)
Entity type:Individual
Prefix:MRS
First Name:KAITLYN
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:KAITLYN
Other - Middle Name:
Other - Last Name:VAN BEVEREN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LPC
Mailing Address - Street 1:1979 N MILL ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-1200
Mailing Address - Country:US
Mailing Address - Phone:815-514-6112
Mailing Address - Fax:
Practice Address - Street 1:1979 N MILL ST
Practice Address - Street 2:SUITE 202
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-1200
Practice Address - Country:US
Practice Address - Phone:815-514-6112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-03
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.011425101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional