Healthcare Provider Details

I. General information

NPI: 1922473164
Provider Name (Legal Business Name): CAITLIN ZATKOFF
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2015
Last Update Date: 02/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17421 TELEGRAPH RD
DETROIT MI
48219-3165
US

IV. Provider business mailing address

640 TEMPLE ST
DETROIT MI
48201-2599
US

V. Phone/Fax

Practice location:
  • Phone: 313-865-0356
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: