Provider Demographics
NPI:1821589128
Name:PARKMAN, KAITLYN (LCPC)
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:
Last Name:PARKMAN
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:KAITLYN
Other - Middle Name:
Other - Last Name:HEMMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:734 HARTMAN LN
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IL
Mailing Address - Zip Code:62298-1860
Mailing Address - Country:US
Mailing Address - Phone:618-520-4800
Mailing Address - Fax:
Practice Address - Street 1:220 BRADFORD LN STE C
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IL
Practice Address - Zip Code:62298-3370
Practice Address - Country:US
Practice Address - Phone:618-939-4444
Practice Address - Fax:618-939-4181
Is Sole Proprietor?:No
Enumeration Date:2018-05-22
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL80011863101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional