Provider Demographics
NPI:1902286750
Name:AGREDA, CAITLIN M (AUD)
Entity Type:Individual
Prefix:DR
First Name:CAITLIN
Middle Name:M
Last Name:AGREDA
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:CAITLIN
Other - Middle Name:M
Other - Last Name:COTTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:PO BOX 415348
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-5348
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:55 LAKE AVE N
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01655-0002
Practice Address - Country:US
Practice Address - Phone:088-563-9965
Practice Address - Fax:774-442-5170
Is Sole Proprietor?:No
Enumeration Date:2015-06-08
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MASP-1064-AU231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist