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General NPI Number Information
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NPI Number | 1790183630
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Entity Type | Individual
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Provider Name | CAITLIN SJOSTRAND
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Gender | Female
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Dates
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Enumeration Date | 12/09/2014
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Last Update Date | 12/09/2014
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Provider Practice Location Address
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Address Line | 12400 TUNNEL HILL RD
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City | CROOKSVILLE
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State | OH
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Zip | 43731-9558
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Country | US
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Telephone | 740-982-7010
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Fax |
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Provider Business Mailing Address
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Address Line | 1085 BERWYN LN
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City | NEWARK
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State | OH
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Zip | 43055-1673
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number | OH3151543
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License Number State | OH
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