Provider Demographics
NPI:1821695115
Name:SEARS, CAITLIN G (SLP-CCC)
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:G
Last Name:SEARS
Suffix:
Gender:F
Credentials:SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1502 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46617-2532
Mailing Address - Country:US
Mailing Address - Phone:717-341-5373
Mailing Address - Fax:
Practice Address - Street 1:1640 AUTUMN BLAZE LN
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:IN
Practice Address - Zip Code:46526-7000
Practice Address - Country:US
Practice Address - Phone:317-653-5767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-08
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22006124A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty