Provider Demographics
NPI:1326866534
Name:BIRDSONG, KAITLYN JULIANA
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:JULIANA
Last Name:BIRDSONG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:261 E OASIS ST
Mailing Address - Street 2:
Mailing Address - City:BLYTHE
Mailing Address - State:CA
Mailing Address - Zip Code:92225-1283
Mailing Address - Country:US
Mailing Address - Phone:760-623-3545
Mailing Address - Fax:
Practice Address - Street 1:261 E OASIS ST
Practice Address - Street 2:
Practice Address - City:BLYTHE
Practice Address - State:CA
Practice Address - Zip Code:92225-1283
Practice Address - Country:US
Practice Address - Phone:760-623-3545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-27
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician