Provider Demographics
NPI:1679087472
Name:SMITH, CAITLYN ANNE (SLP)
Entity Type:Individual
Prefix:
First Name:CAITLYN
Middle Name:ANNE
Last Name:SMITH
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 CONCORD DR
Mailing Address - Street 2:
Mailing Address - City:CHICAGO HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60411-3916
Mailing Address - Country:US
Mailing Address - Phone:708-668-9125
Mailing Address - Fax:
Practice Address - Street 1:401 CONCORD DR
Practice Address - Street 2:
Practice Address - City:CHICAGO HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60411-3916
Practice Address - Country:US
Practice Address - Phone:708-668-9125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-01
Last Update Date:2017-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist