Healthcare Provider Details

I. General information

NPI: 1548170400
Provider Name (Legal Business Name): CAITLYNN VANLANDINGHAM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CAITLYNN JEAN

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1102 MARSHLYN DR
NILES MI
49120-3965
US

IV. Provider business mailing address

1102 MARSHLYN DR
NILES MI
49120-3965
US

V. Phone/Fax

Practice location:
  • Phone: 269-466-0246
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6851122739
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: