Provider Demographics
NPI:1457707820
Name:MARTIN, CAITLIN M (MS, CF-SLP)
Entity type:Individual
Prefix:
First Name:CAITLIN
Middle Name:M
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MS, CF-SLP
Other - Prefix:
Other - First Name:CAITLIN
Other - Middle Name:M
Other - Last Name:WILKEWITZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7030 BLAZING TRAIL DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80922-3052
Mailing Address - Country:US
Mailing Address - Phone:317-340-8285
Mailing Address - Fax:
Practice Address - Street 1:108 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:WAYNETOWN
Practice Address - State:IN
Practice Address - Zip Code:47990-8022
Practice Address - Country:US
Practice Address - Phone:131-734-0828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-04
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN460002846A390200000X
IN22006426235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201376470Medicaid
IN201376470Medicaid