Provider Demographics
NPI:1124009972
Name:CALDWELL, MARION LAWRENCE (AUD)
Entity Type:Individual
Prefix:MRS
First Name:MARION
Middle Name:LAWRENCE
Last Name:CALDWELL
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3940 S DANVILLE BYP
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40422-2529
Mailing Address - Country:US
Mailing Address - Phone:859-236-3865
Mailing Address - Fax:859-236-1690
Practice Address - Street 1:3940 S DANVILLE BYP
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:KY
Practice Address - Zip Code:40422-2529
Practice Address - Country:US
Practice Address - Phone:859-236-3865
Practice Address - Fax:859-236-1690
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-09
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY0106237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY611323166OtherTRICARE
KY640004050OtherRAILROAD MEDICARE
KY000000065710OtherANTHEM/BLUE CROSS BLUE SH
KY611323166OtherTAX ID NUMBER
KYS85550Medicare UPIN
KY3016301Medicare ID - Type Unspecified