Provider Demographics
NPI:1326415720
Name:CALDWELL, LISA (MS)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:CALDWELL
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2116 CATON WAY SW STE 102
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-1176
Mailing Address - Country:US
Mailing Address - Phone:206-496-2770
Mailing Address - Fax:
Practice Address - Street 1:2116 CATON WAY SW STE 102
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502
Practice Address - Country:US
Practice Address - Phone:206-496-2770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-01
Last Update Date:2019-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANU60681879133N00000X
WALH60848403101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No133N00000XDietary & Nutritional Service ProvidersNutritionist