Provider Demographics
NPI:1720867898
Name:WILSON, CAITLYN B
Entity Type:Individual
Prefix:
First Name:CAITLYN
Middle Name:B
Last Name:WILSON
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 1:118 ORTHELLO CT
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70507-5346
Mailing Address - Country:US
Mailing Address - Phone:337-680-0586
Mailing Address - Fax:
Practice Address - Street 1:124 ABIGAYLE ROW
Practice Address - Street 2:
Practice Address - City:SCOTT
Practice Address - State:LA
Practice Address - Zip Code:70583-8909
Practice Address - Country:US
Practice Address - Phone:337-504-2655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-27
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation