Provider Demographics
NPI:1508668948
Name:CAUDILL, KATELYNN GRACE
Entity type:Individual
Prefix:MISS
First Name:KATELYNN
Middle Name:GRACE
Last Name:CAUDILL
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 1:1064 SUMMIT DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45042-3400
Mailing Address - Country:US
Mailing Address - Phone:513-318-7022
Mailing Address - Fax:513-318-7082
Practice Address - Street 1:1064 SUMMIT DRIVE
Practice Address - Street 2:MIDDLETOWN
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45042-3400
Practice Address - Country:US
Practice Address - Phone:513-318-7022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-26
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician