Provider Demographics
NPI:1215656707
Name:CARR, CAITLIN ELIZABETH
Entity type:Individual
Prefix:
First Name:CAITLIN
Middle Name:ELIZABETH
Last Name:CARR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1045 YELLOW BRICK RD APT 118
Mailing Address - Street 2:
Mailing Address - City:CHASKA
Mailing Address - State:MN
Mailing Address - Zip Code:55318-2171
Mailing Address - Country:US
Mailing Address - Phone:952-836-5213
Mailing Address - Fax:
Practice Address - Street 1:145 HAMEL RD
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:MN
Practice Address - Zip Code:55340-9535
Practice Address - Country:US
Practice Address - Phone:651-756-9107
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-26
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor