Healthcare Provider Details

I. General information

NPI: 1699307058
Provider Name (Legal Business Name): DR. CAITLIN M COX
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CATILIN M GREGORY

II. Dates (important events)

Enumeration Date: 02/04/2020
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 W LOSEY ST
SCOTT AIR FORCE BASE IL
62225-5250
US

IV. Provider business mailing address

310 W LOSEY ST
SCOTT AIR FORCE BASE IL
62225-5250
US

V. Phone/Fax

Practice location:
  • Phone: 618-256-7386
  • Fax:
Mailing address:
  • Phone: 618-256-9355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number0810009149
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: