Healthcare Provider Details

I. General information

NPI: 1902242811
Provider Name (Legal Business Name): TAMATHA L CAUCKWELL M.S CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2013
Last Update Date: 03/01/2021
Certification Date: 03/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

166 HAW RIVER RD
FLETCHER NC
28732-6723
US

IV. Provider business mailing address

166 HAW RIVER RD
FLETCHER NC
28732-6723
US

V. Phone/Fax

Practice location:
  • Phone: 916-803-7303
  • Fax:
Mailing address:
  • Phone: 916-803-7303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP 17330
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP 1388
License Number StateNV
# 3
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number12581
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: