Provider Demographics
NPI:1972987642
Name:WELLS, CAITLIN
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:
Last Name:WELLS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17900 DIXIE HWY STE 11
Mailing Address - Street 2:
Mailing Address - City:HOMEWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60430-3008
Mailing Address - Country:US
Mailing Address - Phone:815-540-0389
Mailing Address - Fax:815-880-7979
Practice Address - Street 1:17900 DIXIE HWY STE 11
Practice Address - Street 2:
Practice Address - City:HOMEWOOD
Practice Address - State:IL
Practice Address - Zip Code:60430-3008
Practice Address - Country:US
Practice Address - Phone:815-540-0389
Practice Address - Fax:815-880-7979
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-13
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490172061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical