Provider Demographics
NPI:1114490083
Name:PFAFF, CAITLIN ARIEL (LADC)
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:ARIEL
Last Name:PFAFF
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1821 UNIVERSITY AVE W STE N385
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-2872
Mailing Address - Country:US
Mailing Address - Phone:612-326-7583
Mailing Address - Fax:651-647-9147
Practice Address - Street 1:1821 UNIVERSITY AVE W STE N385
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-2872
Practice Address - Country:US
Practice Address - Phone:612-326-7583
Practice Address - Fax:651-647-9147
Is Sole Proprietor?:No
Enumeration Date:2019-01-03
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN305336101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN205557491Medicaid