| Organization Name: | KAITLYN LAURIE, S.C |
| NPI Number: | 1033409677 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | KAITLYN LAURIE (OWNER) |
| Mailing Address: | 6320 Monona Dr Monona |
| State: | WI US |
| Postal Code: | 537163952 |
| Phone Number: | 6082353546 |
| Fax Number: | |
| NPI Enumeration Date: | 04/17/2011 |
| NPI Last Update Date: | 04/17/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 1915125 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WI |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |