Healthcare Provider Details

I. General information

NPI: 1326415720
Provider Name (Legal Business Name): LISA CALDWELL MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2015
Last Update Date: 11/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2116 CATON WAY SW STE 102
OLYMPIA WA
98502
US

IV. Provider business mailing address

2116 CATON WAY SW STE 102
OLYMPIA WA
98502-1176
US

V. Phone/Fax

Practice location:
  • Phone: 206-496-2770
  • Fax:
Mailing address:
  • Phone: 206-496-2770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License NumberNU60681879
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH60848403
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: