Provider Demographics
NPI:1679080972
Name:TRASK, CAITLAN (MA CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:CAITLAN
Middle Name:
Last Name:TRASK
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:CAITLAN
Other - Middle Name:
Other - Last Name:NAGEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:602 HERITAGE LN APT A
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33770-2170
Mailing Address - Country:US
Mailing Address - Phone:727-412-1214
Mailing Address - Fax:
Practice Address - Street 1:3600 OAK MANOR LN
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33774-1212
Practice Address - Country:US
Practice Address - Phone:727-581-9427
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-08
Last Update Date:2019-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA16800235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist