Healthcare Provider Details

I. General information

NPI: 1003421868
Provider Name (Legal Business Name): CAITLIN CUNNINGHAM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2020
Last Update Date: 02/19/2025
Certification Date: 02/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4015 W DUBLIN GRANVILLE RD
DUBLIN OH
43017-1436
US

IV. Provider business mailing address

4015 W DUBLIN GRANVILLE RD
DUBLIN OH
43017-1436
US

V. Phone/Fax

Practice location:
  • Phone: 614-451-4465
  • Fax:
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 Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: