Provider Demographics
NPI:1093062986
Name:CALDWELL, ANTONIO (MED, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ANTONIO
Middle Name:
Last Name:CALDWELL
Suffix:
Gender:M
Credentials:MED, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3514 LYNDALE AVE N
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55412-2558
Mailing Address - Country:US
Mailing Address - Phone:612-803-5038
Mailing Address - Fax:
Practice Address - Street 1:3514 LYNDALE AVE N
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55412-2558
Practice Address - Country:US
Practice Address - Phone:612-803-5038
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-09
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9068235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist