Provider Demographics
NPI:1528725512
Name:UNDERWOOD, KAITLYN (LCSW)
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:
Last Name:UNDERWOOD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2620 CONNERY WAY
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59808-1325
Mailing Address - Country:US
Mailing Address - Phone:406-599-4205
Mailing Address - Fax:
Practice Address - Street 1:2620 CONNERY WAY
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59808-1325
Practice Address - Country:US
Practice Address - Phone:406-203-9948
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-24
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT705031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical