Healthcare Provider Details

I. General information

NPI: 1306622097
Provider Name (Legal Business Name): CAITLYN ANDERS LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CAITLYN BLAKELY

II. Dates (important events)

Enumeration Date: 09/07/2023
Last Update Date: 09/07/2023
Certification Date: 09/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

670 ALBEMARLE DR BLDG 7
SHREVEPORT LA
71106-5945
US

IV. Provider business mailing address

4423 NORWAY DR
SHREVEPORT LA
71105-3123
US

V. Phone/Fax

Practice location:
  • Phone: 318-562-6903
  • Fax:
Mailing address:
  • Phone: 318-499-1655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number18101
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: