Healthcare Provider Details

I. General information

NPI: 1386306546
Provider Name (Legal Business Name): NATHAN K CAULDER LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2021
Last Update Date: 10/06/2021
Certification Date: 10/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 HAWTHORNE AVE SE STE A130
SALEM OR
97301-0074
US

IV. Provider business mailing address

5784 BARBARESCO ST S
SALEM OR
97306-4104
US

V. Phone/Fax

Practice location:
  • Phone: 541-900-4285
  • Fax:
Mailing address:
  • Phone: 150-394-9353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number10645
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: