MEDICARE: MS. CAITLIN EMILY MYERS LICSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	21219	MN
2	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1841741626
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CAITLIN EMILY MYERS LICSW

Provider Business Mailing Address
First Line	:	2612 CARLSON DR NW
Second Line	:
City	:	COON RAPIDS
State	:	MN
Zip	:	55433-1807
Country	:	US
Telephone Number	:	920-858-0311
Fax Number	:

Provider Business Practice Location Address
First Line	:	2324 UNIVERSITY AVE W STE 120
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55114-1854
Country	:	US
Telephone Number	:	651-644-4100
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/17/2016
Last Update Date	:	02/23/2026

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