Provider Demographics
NPI:1215706999
Name:HORNBACK, CAITLIN LILLIAN
Entity type:Individual
Prefix:
First Name:CAITLIN
Middle Name:LILLIAN
Last Name:HORNBACK
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 1:1387 ROSEMAN BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WINTERSET
Mailing Address - State:IA
Mailing Address - Zip Code:50273-8426
Mailing Address - Country:US
Mailing Address - Phone:515-829-0956
Mailing Address - Fax:
Practice Address - Street 1:287 SE WESTOWN PARKWAY
Practice Address - Street 2:
Practice Address - City:WAUKEE
Practice Address - State:IA
Practice Address - Zip Code:50263
Practice Address - Country:US
Practice Address - Phone:515-446-3403
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-22
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst