Provider Demographics
NPI:1447314604
Name:HAYDEN, KATHLEEN ELAINE (MSW)
Entity type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:ELAINE
Last Name:HAYDEN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 1ST AVE E
Mailing Address - Street 2:#17
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901
Mailing Address - Country:US
Mailing Address - Phone:406-752-2523
Mailing Address - Fax:406-756-1696
Practice Address - Street 1:307 1ST AVE E
Practice Address - Street 2:#17
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901
Practice Address - Country:US
Practice Address - Phone:406-752-2523
Practice Address - Fax:406-756-1696
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTP42023Medicaid
P42023Medicare UPIN