Healthcare Provider Details

I. General information

NPI: 1053935379
Provider Name (Legal Business Name): CAITLIN MARIE BUTCHER BSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2020
Last Update Date: 09/30/2024
Certification Date: 09/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2555 S DIXIE DR STE 260
DAYTON OH
45409-1542
US

IV. Provider business mailing address

10100 ELIDA RD
DELPHOS OH
45833-9056
US

V. Phone/Fax

Practice location:
  • Phone: 937-853-9061
  • Fax: 937-853-9069
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.2411497
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: