Provider Demographics
NPI:1396136255
Name:GAVIN, KALEEN
Entity type:Individual
Prefix:
First Name:KALEEN
Middle Name:
Last Name:GAVIN
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:PO BOX 74
Mailing Address - Street 2:
Mailing Address - City:HAZLETON
Mailing Address - State:IA
Mailing Address - Zip Code:50641-0074
Mailing Address - Country:US
Mailing Address - Phone:319-327-0521
Mailing Address - Fax:
Practice Address - Street 1:105 MAIN STREET SOUTH
Practice Address - Street 2:
Practice Address - City:HAZLETON
Practice Address - State:IA
Practice Address - Zip Code:50641
Practice Address - Country:US
Practice Address - Phone:319-327-0521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-02-13
Last Update Date:2015-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)