Provider Demographics
NPI:1396281507
Name:SMITH, KAITLEND TATIANA (BA)
Entity type:Individual
Prefix:MISS
First Name:KAITLEND
Middle Name:TATIANA
Last Name:SMITH
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4899 HILDRETH LN
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95212-1408
Mailing Address - Country:US
Mailing Address - Phone:209-513-7715
Mailing Address - Fax:
Practice Address - Street 1:4899 HILDRETH LN
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95212-1408
Practice Address - Country:US
Practice Address - Phone:209-513-7715
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-11
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst