Healthcare Provider Details

I. General information

NPI: 1295233922
Provider Name (Legal Business Name): CAITLIN T CONNELLY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2018
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1324 W CLAIREMONT AVE STE 6
EAU CLAIRE WI
54701-6191
US

IV. Provider business mailing address

1324 W CLAIREMONT AVE STE 6
EAU CLAIRE WI
54701-6191
US

V. Phone/Fax

Practice location:
  • Phone: 507-494-8107
  • Fax:
Mailing address:
  • Phone: 507-494-8107
  • Fax: 920-714-0597

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number7726-125
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: