Provider Demographics
NPI:1700494291
Name:GRANDFIELD, CAITLIN (LCGC)
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:
Last Name:GRANDFIELD
Suffix:
Gender:F
Credentials:LCGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:537 N AVENUE H APT 805
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83712-6439
Mailing Address - Country:US
Mailing Address - Phone:925-812-3029
Mailing Address - Fax:
Practice Address - Street 1:333 N 1ST ST STE 150
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-6135
Practice Address - Country:US
Practice Address - Phone:208-381-3333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-21
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDGENP-225170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS