| NPI | 1548680507 |
|---|---|
| Former Name | CAITLIN MARTHA MELLENCAMP |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: KS 05-41092) |
| Enumeration Date | 2014-04-17 |
| Last Update Date | 2020-01-24 |