Provider Demographics
NPI:1013465889
Name:WASSERBERGER, CAITLIN BELL (BCBA)
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:BELL
Last Name:WASSERBERGER
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1235 SLAYTON AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:49417-1945
Mailing Address - Country:US
Mailing Address - Phone:708-955-2205
Mailing Address - Fax:
Practice Address - Street 1:2211 E BELTLINE AVE NE STE C
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-9802
Practice Address - Country:US
Practice Address - Phone:616-202-4840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-21
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7401001949103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst