Provider Demographics
NPI:1750073557
Name:CALDWELL, MANDY L
Entity type:Individual
Prefix:
First Name:MANDY
Middle Name:L
Last Name:CALDWELL
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 1:2023 SUNSET BLVD
Mailing Address - Street 2:
Mailing Address - City:STEUBENVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43952-1349
Mailing Address - Country:US
Mailing Address - Phone:740-792-4012
Mailing Address - Fax:
Practice Address - Street 1:1313 STATE ROUTE 646
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:OH
Practice Address - Zip Code:43944-7958
Practice Address - Country:US
Practice Address - Phone:330-407-0784
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator