Provider Demographics
NPI:1508481359
Name:MCINNIS, CAITLIN ELIZABETH (AUD)
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:ELIZABETH
Last Name:MCINNIS
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 N TEXAS AVE STE 3100
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-4970
Mailing Address - Country:US
Mailing Address - Phone:281-338-7135
Mailing Address - Fax:281-525-4183
Practice Address - Street 1:333 N TEXAS AVE STE 3100
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4970
Practice Address - Country:US
Practice Address - Phone:281-338-7135
Practice Address - Fax:281-525-4183
Is Sole Proprietor?:No
Enumeration Date:2020-06-08
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX81151231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist