Provider Demographics
NPI:1164111621
Name:CALDWELL, TAYLOR MARLANE
Entity Type:Individual
Prefix:MRS
First Name:TAYLOR
Middle Name:MARLANE
Last Name:CALDWELL
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 1:128 BLAKELY RD
Mailing Address - Street 2:
Mailing Address - City:RANDLE
Mailing Address - State:WA
Mailing Address - Zip Code:98377-9013
Mailing Address - Country:US
Mailing Address - Phone:360-304-1551
Mailing Address - Fax:
Practice Address - Street 1:3510 STEELHAMMER DR
Practice Address - Street 2:
Practice Address - City:CENTRALIA
Practice Address - State:WA
Practice Address - Zip Code:98531-4551
Practice Address - Country:US
Practice Address - Phone:360-623-8020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-02
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health