Provider Demographics
NPI:1982302402
Name:BRUMMETT, KAITLIN (LSW)
Entity type:Individual
Prefix:
First Name:KAITLIN
Middle Name:
Last Name:BRUMMETT
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:534 E LUCY LN
Mailing Address - Street 2:
Mailing Address - City:ELLETTSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47429-2058
Mailing Address - Country:US
Mailing Address - Phone:504-520-0172
Mailing Address - Fax:
Practice Address - Street 1:818 MADISON ST
Practice Address - Street 2:
Practice Address - City:ROCKPORT
Practice Address - State:IN
Practice Address - Zip Code:47635-1241
Practice Address - Country:US
Practice Address - Phone:504-520-0172
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-23
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker