Healthcare Provider Details

I. General information

NPI: 1508697335
Provider Name (Legal Business Name): VIRGINIA ANN CALDWELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2024
Last Update Date: 08/13/2024
Certification Date: 08/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15945 WOOD RD
LANSING MI
48906-1746
US

IV. Provider business mailing address

5252 BLUE HAVEN DR
EAST LANSING MI
48823-3873
US

V. Phone/Fax

Practice location:
  • Phone: 517-394-1234
  • Fax:
Mailing address:
  • Phone: 517-214-2716
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number07706
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: