Provider Demographics
NPI:1427876895
Name:GRANNEMANN, KAITLYN (MA, LMHC)
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:
Last Name:GRANNEMANN
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 SE 18TH TER
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33990-2269
Mailing Address - Country:US
Mailing Address - Phone:239-292-8300
Mailing Address - Fax:
Practice Address - Street 1:2348 LAUREL RD E UNIT 8101
Practice Address - Street 2:
Practice Address - City:NOKOMIS
Practice Address - State:FL
Practice Address - Zip Code:34275-3548
Practice Address - Country:US
Practice Address - Phone:239-292-8300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-02
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH24375101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health