Kaitlin J Portz, PHD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

071.010140 Issued in IL

Practice address

4921 Parkview PL
Saint Louis, MO 63110-1032

Phone

(314) 747-5587

NPI assigned

Apr 29, 2020

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Kaitlin J Huelsman Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1588118400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1591747200000",
    "number": "1912528100",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105 S HIGH ST",
            "city": "SHILOH",
            "state": "IL",
            "postal_code": "622692920"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4921 PARKVIEW PL",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631101032",
            "telephone_number": "314-747-5587"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "105 S High St",
            "address_purpose": "LOCATION",
            "city": "Shiloh",
            "state": "IL",
            "postal_code": "622692920",
            "country_code": "US",
            "telephone_number": "833-571-0951",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PORTZ",
        "first_name": "KAITLIN",
        "middle_name": "J",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-04-29",
        "last_updated": "2020-06-10",
        "certification_date": "2020-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MO",
            "license": "2018043609",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071.010140",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KAITLIN",
            "last_name": "HUELSMAN",
            "middle_name": "J",
            "credential": "PHD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Shulamit Menashe Portnoy, MD
• Steven Michael Portnoy, LPC
• Aileen Portugal, MD
• Miranda Portwine, CRNA
• Katherin Elizabeth Portwood, MD
• Christopher Erik Posey, CRNA
• Grace Posey, MD
• Tracy Renee Posey, M.S., OTR/L
• Positive by Design LLC
• Positive Family Dynamics,PC

• Clinical Psychologist in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Clinical Psychologist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.