Provider Demographics
NPI:1851911192
Name:BURDETT, CAITLIN ELISE (LLMSW)
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:ELISE
Last Name:BURDETT
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:CAITLIN
Other - Middle Name:ELISE
Other - Last Name:HICKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:909 S FRANKS AVE
Mailing Address - Street 2:
Mailing Address - City:STURGIS
Mailing Address - State:MI
Mailing Address - Zip Code:49091-1687
Mailing Address - Country:US
Mailing Address - Phone:269-659-1560
Mailing Address - Fax:
Practice Address - Street 1:909 S FRANKS AVE
Practice Address - Street 2:
Practice Address - City:STURGIS
Practice Address - State:MI
Practice Address - Zip Code:49091-1687
Practice Address - Country:US
Practice Address - Phone:269-659-1560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-16
Last Update Date:2020-08-27
Deactivation Date:2020-04-16
Deactivation Code:
Reactivation Date:2020-05-20
Provider Licenses
StateLicense IDTaxonomies
MI68011023881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical