Provider Demographics
NPI:1134802622
Name:JAYNE, CAITLYN ROSE
Entity type:Individual
Prefix:
First Name:CAITLYN
Middle Name:ROSE
Last Name:JAYNE
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 1:19201 E VALLEY VIEW PKWY STE H
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64055-6913
Mailing Address - Country:US
Mailing Address - Phone:816-474-3995
Mailing Address - Fax:
Practice Address - Street 1:19201 E VALLEY VIEW PKWY STE H
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64055-6913
Practice Address - Country:US
Practice Address - Phone:816-474-3995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-10
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician