Healthcare Provider Details

I. General information

NPI: 1851757637
Provider Name (Legal Business Name): CAITLIN EILEEN WILTERINK MS, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2016
Last Update Date: 07/24/2025
Certification Date: 07/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3152 PEREGRINE DR NE
GRAND RAPIDS MI
49525-9723
US

IV. Provider business mailing address

3152 PEREGRINE DR NE
GRAND RAPIDS MI
49525-9723
US

V. Phone/Fax

Practice location:
  • Phone: 616-643-0833
  • Fax:
Mailing address:
  • Phone: 616-643-0833
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number7101005023
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: