Provider Demographics
NPI:1417434788
Name:CROEGAERT KOCH, CAITLIN KRISTI (SLP)
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:KRISTI
Last Name:CROEGAERT KOCH
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:CAITLYN
Other - Middle Name:KRISTI
Other - Last Name:CROEGAERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7974 UW HEALTH CT
Mailing Address - Street 2:
Mailing Address - City:MIDDLETON
Mailing Address - State:WI
Mailing Address - Zip Code:53562-5531
Mailing Address - Country:US
Mailing Address - Phone:068-829-5485
Mailing Address - Fax:
Practice Address - Street 1:600 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53792-0001
Practice Address - Country:US
Practice Address - Phone:608-265-7760
Practice Address - Fax:608-265-7004
Is Sole Proprietor?:No
Enumeration Date:2018-07-19
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2864-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist