Provider Demographics
NPI:1346511680
Name:ILTIS, CAROLINE ANNE
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:ANNE
Last Name:ILTIS
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 1:315 W HALEY ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93101-3471
Mailing Address - Country:US
Mailing Address - Phone:805-963-1086
Mailing Address - Fax:805-963-5061
Practice Address - Street 1:315 W HALEY ST
Practice Address - Street 2:C/O PATHPOINT, SUITE 102
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93101-3471
Practice Address - Country:US
Practice Address - Phone:805-963-1086
Practice Address - Fax:805-963-5061
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-18
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker