Healthcare Provider Details

I. General information

NPI: 1972400778
Provider Name (Legal Business Name): LAURA CALDWELL M.ED. NCSP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2026
Last Update Date: 10/23/2026
Certification Date: 10/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6079 MIDDLE RIDGE RD
MADISON OH
44057-2805
US

IV. Provider business mailing address

6233 GLENWOOD DR
MENTOR OH
44060-2455
US

V. Phone/Fax

Practice location:
  • Phone: 440-428-1196
  • Fax:
Mailing address:
  • Phone: 440-290-9521
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberLSP.01373
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: