Provider Demographics
NPI:1679944490
Name:AYOTTE, KRISTIN GRACE
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:GRACE
Last Name:AYOTTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 BOLDUC AVE
Mailing Address - Street 2:
Mailing Address - City:FORT KENT
Mailing Address - State:ME
Mailing Address - Zip Code:04743-1602
Mailing Address - Country:US
Mailing Address - Phone:207-834-3971
Mailing Address - Fax:
Practice Address - Street 1:12 BOLDUC AVE
Practice Address - Street 2:
Practice Address - City:FORT KENT
Practice Address - State:ME
Practice Address - Zip Code:04743-1602
Practice Address - Country:US
Practice Address - Phone:207-834-3971
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-20
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMC156401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical