Kaitlin Hazel, MHT

Individual provider Active NPI Other Technician · Grand Forks, ND

NPI 1376201228 · NPPES record last updated Dec 7, 2021

Key facts

NPI
1376201228
Entity type
Individual (NPI type 1)
Primary specialty
Other Technician 247200000X
License
10597
Practice address
930 N 3Rd St
Grand Forks, ND 58203-2408
Phone
(701) 795-9143
NPI assigned
Dec 7, 2021
Sex
Female
Sole proprietor
No

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

Practice roles

OrganizationSpecialtyStatusNew patients
Prairie Harvest Mental Health Current
since Dec 12, 2021
Accepting new patients

Locations

930 N 3rd St
Grand Forks, ND 58203
Phone (701) 795-9143

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Other Technician 247200000X 10597 Yes

Addresses

Primary practice location

930 N 3Rd St
Grand Forks, ND 58203-2408

Mailing address

930 N 3Rd St
Grand Forks, ND 58203-2408

Other providers in Grand Forks, ND

All providers in Grand Forks, ND · Other Technician in North Dakota

Sources for this page

Verify at the official NPI Registry.