Provider Demographics
NPI:1528582236
Name:SECRIST, CAITLIN (MA, CF-SLP)
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:
Last Name:SECRIST
Suffix:
Gender:F
Credentials:MA, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71A WEST ST
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28801-1136
Mailing Address - Country:US
Mailing Address - Phone:804-912-0501
Mailing Address - Fax:
Practice Address - Street 1:9 SUMMIT AVENUE
Practice Address - Street 2:B
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803
Practice Address - Country:US
Practice Address - Phone:828-670-8056
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-03
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1804243235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty