Provider Demographics
NPI:1285264366
Name:HAMANN, KAITLIN NICOLLE (LMSW)
Entity type:Individual
Prefix:
First Name:KAITLIN
Middle Name:NICOLLE
Last Name:HAMANN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:KAITLIN
Other - Middle Name:NICOLLE
Other - Last Name:HURLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LLMSW
Mailing Address - Street 1:2820 BAKER RD
Mailing Address - Street 2:
Mailing Address - City:DEXTER
Mailing Address - State:MI
Mailing Address - Zip Code:48130-1181
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3496 E LAKE LANSING RD
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-2288
Practice Address - Country:US
Practice Address - Phone:586-850-9720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-17
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801106287101YM0800X
MI68511062871041C0700X
MI68011143351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health