Provider Demographics
NPI:1730073362
Name:RYNNING, KAITLYN ALLIE (MSW)
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:ALLIE
Last Name:RYNNING
Suffix:
Gender:F
Credentials:MSW
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 1182
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91722-0182
Mailing Address - Country:US
Mailing Address - Phone:951-640-2818
Mailing Address - Fax:
Practice Address - Street 1:4140 HARRISON ST
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-3516
Practice Address - Country:US
Practice Address - Phone:951-640-2818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-06
Last Update Date:2025-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical