Provider Demographics
NPI:1902644651
Name:MARKS, CAITLIN M (SLP)
Entity type:Individual
Prefix:
First Name:CAITLIN
Middle Name:M
Last Name:MARKS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:ALTO PASS
Mailing Address - State:IL
Mailing Address - Zip Code:62905-1031
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:751 ULLIN AVE
Practice Address - Street 2:
Practice Address - City:ULLIN
Practice Address - State:IL
Practice Address - Zip Code:62992-1014
Practice Address - Country:US
Practice Address - Phone:618-634-9800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-17
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242007885235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist