Provider Demographics
NPI:1558876334
Name:PURKS, CAITLYN (CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:CAITLYN
Middle Name:
Last Name:PURKS
Suffix:
Gender:F
Credentials:CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9386 N HIGHWAY 6
Mailing Address - Street 2:
Mailing Address - City:CRAWFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76638-2849
Mailing Address - Country:US
Mailing Address - Phone:254-644-2423
Mailing Address - Fax:254-848-4193
Practice Address - Street 1:500 SOUTH ST STE 300
Practice Address - Street 2:
Practice Address - City:VIDOR
Practice Address - State:TX
Practice Address - Zip Code:77662-6183
Practice Address - Country:US
Practice Address - Phone:254-644-2770
Practice Address - Fax:254-848-4193
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-03
Last Update Date:2019-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist