=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972400778
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LAURA CALDWELL M.ED. NCSP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/23/2026
-----------------------------------------------------
Last Update Date | 10/23/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6079 MIDDLE RIDGE RD
-----------------------------------------------------
City | MADISON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44057-2805
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-428-1196
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6233 GLENWOOD DR
-----------------------------------------------------
City | MENTOR
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44060-2455
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-290-9521
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TS0200X
-----------------------------------------------------
Taxonomy Name | School Psychologist
-----------------------------------------------------
License Number | LSP.01373
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------