Provider Demographics
NPI:1275878332
Name:LEETE, CAITLIN TOWER (SLP)
Entity Type:Individual
Prefix:MRS
First Name:CAITLIN
Middle Name:TOWER
Last Name:LEETE
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:MISS
Other - First Name:CAITLIN
Other - Middle Name:TOWER
Other - Last Name:LEETE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CF-SLP
Mailing Address - Street 1:2302 N 15TH AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85007-1201
Mailing Address - Country:US
Mailing Address - Phone:602-265-4124
Mailing Address - Fax:602-248-8843
Practice Address - Street 1:2302 N 15TH AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85007-1201
Practice Address - Country:US
Practice Address - Phone:602-265-4124
Practice Address - Fax:602-248-8843
Is Sole Proprietor?:No
Enumeration Date:2012-11-30
Last Update Date:2012-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZTSLP7778235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ459140Medicaid