Provider Demographics
NPI:1891539870
Name:KERSEY, CAITLYN ANDREA
Entity type:Individual
Prefix:
First Name:CAITLYN
Middle Name:ANDREA
Last Name:KERSEY
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 1:19420 SE 20TH ST APT 91
Mailing Address - Street 2:
Mailing Address - City:CAMAS
Mailing Address - State:WA
Mailing Address - Zip Code:98607-8685
Mailing Address - Country:US
Mailing Address - Phone:503-799-5002
Mailing Address - Fax:
Practice Address - Street 1:4101 SE 192ND AVE # 101
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-1471
Practice Address - Country:US
Practice Address - Phone:360-605-1881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-24
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician