Provider Demographics
NPI:1366116758
Name:HALVERSON, KAITLYNN (MSW, LICSW)
Entity type:Individual
Prefix:
First Name:KAITLYNN
Middle Name:
Last Name:HALVERSON
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:KAITLYNN
Other - Middle Name:
Other - Last Name:LEBRUN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LGSW
Mailing Address - Street 1:7601 WAYZATA BLVD
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55426-1623
Mailing Address - Country:US
Mailing Address - Phone:612-756-2428
Mailing Address - Fax:
Practice Address - Street 1:7601 WAYZATA BLVD
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55426-1623
Practice Address - Country:US
Practice Address - Phone:612-223-8898
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-09
Last Update Date:2024-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN312731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical