Provider Demographics
NPI:1205384658
Name:DUDENHOEFER, CAITLIN (LPC)
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:
Last Name:DUDENHOEFER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6832 CONVENT BLVD
Mailing Address - Street 2:
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560-4805
Mailing Address - Country:US
Mailing Address - Phone:419-882-4529
Mailing Address - Fax:419-885-7612
Practice Address - Street 1:6832 CONVENT BLVD
Practice Address - Street 2:
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560-4805
Practice Address - Country:US
Practice Address - Phone:419-882-4529
Practice Address - Fax:419-885-7612
Is Sole Proprietor?:No
Enumeration Date:2016-09-14
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC1600344101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional