Provider Demographics
NPI:1053564211
Name:INGRAHAM, CAITLIN MARIE (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:CAITLIN
Middle Name:MARIE
Last Name:INGRAHAM
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:MS
Other - First Name:CAITLIN
Other - Middle Name:MARIE
Other - Last Name:WYATT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:132 E PUTNAM AVE STE 14
Mailing Address - Street 2:
Mailing Address - City:COS COB
Mailing Address - State:CT
Mailing Address - Zip Code:06807-2753
Mailing Address - Country:US
Mailing Address - Phone:203-990-3392
Mailing Address - Fax:203-990-9939
Practice Address - Street 1:132 E PUTNAM AVE STE 14
Practice Address - Street 2:
Practice Address - City:COS COB
Practice Address - State:CT
Practice Address - Zip Code:06807-2753
Practice Address - Country:US
Practice Address - Phone:203-990-3392
Practice Address - Fax:203-990-3393
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-30
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004133235Z00000X
NY019003-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist