Provider Demographics
NPI:1932988524
Name:FORNEY, CAITLYN M
Entity Type:Individual
Prefix:
First Name:CAITLYN
Middle Name:M
Last Name:FORNEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CAITLYN
Other - Middle Name:
Other - Last Name:BLAUSER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3174 MISURINA AVE
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89044-1747
Mailing Address - Country:US
Mailing Address - Phone:702-513-4484
Mailing Address - Fax:
Practice Address - Street 1:4461 E CHARLESTON BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89104-5537
Practice Address - Country:US
Practice Address - Phone:702-791-9050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-25
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor