Healthcare Provider Details

I. General information

NPI: 1073873345
Provider Name (Legal Business Name): CAITLIN ALEXANDRA BISHOP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2012
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 CHRISTIAN AVE
TALENT OR
97540
US

IV. Provider business mailing address

931 CHEVY WAY
MEDFORD OR
97504-4127
US

V. Phone/Fax

Practice location:
  • Phone: 541-535-6239
  • Fax:
Mailing address:
  • Phone: 541-690-3555
  • Fax: 530-894-5791

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberL8559
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: