Provider Demographics
NPI:1063216562
Name:SHERIDAN, KAITLYN ELEANOR
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:ELEANOR
Last Name:SHERIDAN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 614
Mailing Address - Street 2:
Mailing Address - City:IRONTON
Mailing Address - State:OH
Mailing Address - Zip Code:45638-0614
Mailing Address - Country:US
Mailing Address - Phone:740-442-7045
Mailing Address - Fax:740-442-7047
Practice Address - Street 1:PO BOX 614
Practice Address - Street 2:
Practice Address - City:IRONTON
Practice Address - State:OH
Practice Address - Zip Code:45638-0614
Practice Address - Country:US
Practice Address - Phone:740-442-7045
Practice Address - Fax:740-442-7047
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-03
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health