Healthcare Provider Details

I. General information

NPI: 1225750912
Provider Name (Legal Business Name): CAITLYN WESSELS DESPINS CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2022
Last Update Date: 09/19/2022
Certification Date: 09/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17507 LEE HWY
ABINGDON VA
24210-7835
US

IV. Provider business mailing address

516 LADY SLIPPER LN
LYNCHBURG VA
24502-4995
US

V. Phone/Fax

Practice location:
  • Phone: 276-525-6043
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2202010568
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: