Provider Demographics
NPI:1659566495
Name:CAYKO, SHIRLEY SUE (LCSW)
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:SUE
Last Name:CAYKO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 373
Mailing Address - Street 2:
Mailing Address - City:ULM
Mailing Address - State:MT
Mailing Address - Zip Code:59485-0373
Mailing Address - Country:US
Mailing Address - Phone:406-268-1069
Mailing Address - Fax:
Practice Address - Street 1:1601 2ND AVE N STE 400
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59401-3276
Practice Address - Country:US
Practice Address - Phone:406-453-0088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-13
Last Update Date:2015-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT803 LCSW1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT12501880OtherCAQH
MT0000701213OtherBLUE CROSS/BLUE SHIELD OF MT
MT1659566495Medicaid
MTP00692129 C01340OtherRAILROAD MEDICARE
MTM011004792Medicare PIN