Provider Demographics
NPI:1053823393
Name:CAULKINS, KASEY
Entity Type:Individual
Prefix:
First Name:KASEY
Middle Name:
Last Name:CAULKINS
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 1:818 WINIFRED ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49202-3062
Mailing Address - Country:US
Mailing Address - Phone:517-513-3617
Mailing Address - Fax:
Practice Address - Street 1:818 WINIFRED ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49202-3062
Practice Address - Country:US
Practice Address - Phone:517-513-3617
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-26
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst