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NPI Code Detail

MEDICARE: KYLE CAUDLE

MEDICARE: KYLE CAUDLE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1144618026
Entity Type Code : Individual
Provider Name (Legal Business Name) : KYLE CAUDLE
Provider Business Mailing Address
First Line : 10726 NE GLISAN ST
Second Line :
City : PORTLAND
State : OR
Zip : 97220-4046
Country : US
Telephone Number : 503-501-5252
Fax Number :
Provider Business Practice Location Address
First Line : 10726 NE GLISAN ST
Second Line :
City : PORTLAND
State : OR
Zip : 97220-4046
Country : US
Telephone Number : 503-501-5252
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/31/2014
Last Update Date : 12/31/2014

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Directions to “ KYLE CAUDLE ” Practice Location

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