Provider Demographics
NPI:1801366364
Name:WHITEBREAD, KAITLYN (LPC)
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:
Last Name:WHITEBREAD
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:726 HINMAN AVE APT 2E
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-2570
Mailing Address - Country:US
Mailing Address - Phone:440-567-1044
Mailing Address - Fax:
Practice Address - Street 1:726 HINMAN AVE APT 2E
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60202-2570
Practice Address - Country:US
Practice Address - Phone:440-567-1044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-27
Last Update Date:2018-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.013483101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional