MEDICARE: CAITLYN MARIE WARDELL

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	138589	CA

General Provider Information

NPI Number	:	1518621804
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAITLYN MARIE WARDELL

Provider Business Mailing Address
First Line	:	5445 LAUREL HILLS DR
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95841-3105
Country	:	US
Telephone Number	:	916-609-5100
Fax Number	:

Provider Business Practice Location Address
First Line	:	9412 BIG HORN BLVD STE 6
Second Line	:
City	:	ELK GROVE
State	:	CA
Zip	:	95758-1101
Country	:	US
Telephone Number	:	916-226-2800
Fax Number	:

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

Provider Enumeration Date	:	10/24/2021
Last Update Date	:	05/19/2026

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