Healthcare Provider Details

I. General information

NPI: 1992162721
Provider Name (Legal Business Name): CAITLIN WURSTER PSY.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2016
Last Update Date: 01/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

137 N OAK PARK AVE STE 302
OAK PARK IL
60301-1339
US

IV. Provider business mailing address

137 N OAK PARK AVE STE 302
OAK PARK IL
60301-1339
US

V. Phone/Fax

Practice location:
  • Phone: 708-386-5080
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number071009231
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: