Healthcare Provider Details

I. General information

NPI: 1750996674
Provider Name (Legal Business Name): MICHELLE ANN CALDWELL LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2020
Last Update Date: 08/22/2023
Certification Date: 08/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 16TH ST NE STE 206
CEDAR RAPIDS IA
52402-4665
US

IV. Provider business mailing address

700 16TH ST NE STE 206
CEDAR RAPIDS IA
52402-4665
US

V. Phone/Fax

Practice location:
  • Phone: 319-775-0777
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number100458
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: