Provider Demographics
NPI:1952800716
Name:VADER, KAITLIN (MA)
Entity Type:Individual
Prefix:
First Name:KAITLIN
Middle Name:
Last Name:VADER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19714 E HARVARD DR
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80013-9457
Mailing Address - Country:US
Mailing Address - Phone:970-275-9668
Mailing Address - Fax:
Practice Address - Street 1:8405 CHURCH RANCH BLVD
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80021-3918
Practice Address - Country:US
Practice Address - Phone:303-438-2251
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-07
Last Update Date:2018-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPCC.0015775101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health