Provider Demographics
NPI:1295488567
Name:BELLINGER, CAITLIN BROOKE (CCC-SLP)
Entity type:Individual
Prefix:
First Name:CAITLIN
Middle Name:BROOKE
Last Name:BELLINGER
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1208 N BRICKELL DR
Mailing Address - Street 2:
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32725-9068
Mailing Address - Country:US
Mailing Address - Phone:407-718-5663
Mailing Address - Fax:
Practice Address - Street 1:2750 ENTERPRISE RD STE A&B
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-8316
Practice Address - Country:US
Practice Address - Phone:386-446-9935
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-27
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA21987235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL113352700Medicaid
14430938OtherASHA
FLSZ10531OtherFL DEPARTMENT OF HEALTH