Provider Demographics
NPI:1306391677
Name:HENIGE, CAITLIN (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:
Last Name:HENIGE
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:830 ARBOR CREEK DR
Mailing Address - Street 2:APT. 108
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49423-7628
Mailing Address - Country:US
Mailing Address - Phone:810-516-3563
Mailing Address - Fax:
Practice Address - Street 1:830 ARBOR CREEK DR
Practice Address - Street 2:APT. 108
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49423-7628
Practice Address - Country:US
Practice Address - Phone:810-516-3563
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-16
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101004776235Z00000X
KS3516235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist