Provider Demographics
NPI:1053805093
Name:HIEMENZ, CAITLIN MCCLUNG (MS SLP)
Entity type:Individual
Prefix:MRS
First Name:CAITLIN
Middle Name:MCCLUNG
Last Name:HIEMENZ
Suffix:
Gender:F
Credentials:MS SLP
Other - Prefix:MRS
Other - First Name:CAITLIN
Other - Middle Name:MCCLUNG
Other - Last Name:KRUCHTEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3328 26TH AVE S
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56301-5855
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12 1ST AVE S
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:MN
Practice Address - Zip Code:55313-1409
Practice Address - Country:US
Practice Address - Phone:763-682-7774
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-21
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
MN10069235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist