=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194273987
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CAITLIN A DUFOUR LCSW, SAC-IT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/21/2016
-----------------------------------------------------
Last Update Date | 11/01/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 115 5TH AVE N
-----------------------------------------------------
City | HURLEY
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54534-1208
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 715-329-1288
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15735 W US HIGHWAY 63
-----------------------------------------------------
City | HAYWARD
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 54843-6475
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 715-934-0710
-----------------------------------------------------
Fax | 715-598-4881
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | 6801100786
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 9470
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------