MEDICARE: MS. CAITLIN SPIES MA, LICSW

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
1	1041C0700X	Clinical Social Worker	149.016054	IL
2	1041C0700X	Clinical Social Worker	25086	MN

General Provider Information

NPI Number	:	1164855359
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CAITLIN SPIES MA, LICSW

Provider Business Mailing Address
First Line	:	825 NICOLLET MALL
Second Line	:	SUITE 1443
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55402
Country	:	US
Telephone Number	:	612-469-1269
Fax Number	:

Provider Business Practice Location Address
First Line	:	825 NICOLLET MALL STE 1443
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55402-2703
Country	:	US
Telephone Number	:	612-469-1269
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/12/2013
Last Update Date	:	07/21/2022

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