Provider Demographics
NPI:1922696798
Name:MASTERS, CAITLIN MCKISSON (SLP)
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:MCKISSON
Last Name:MASTERS
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 1:802 TEMPLE ST
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-4340
Mailing Address - Country:US
Mailing Address - Phone:419-345-5317
Mailing Address - Fax:
Practice Address - Street 1:2030 LAURA DUNCAN RD
Practice Address - Street 2:
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27523-9267
Practice Address - Country:US
Practice Address - Phone:919-809-5310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-06
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10352235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist