Provider Demographics
NPI:1730920059
Name:CAULEY, KELSEY JANE
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:JANE
Last Name:CAULEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3993 SOUTHWOOD RD
Mailing Address - Street 2:
Mailing Address - City:BALDWIN
Mailing Address - State:FL
Mailing Address - Zip Code:32234-8027
Mailing Address - Country:US
Mailing Address - Phone:904-652-5425
Mailing Address - Fax:
Practice Address - Street 1:3993 SOUTHWOOD RD
Practice Address - Street 2:
Practice Address - City:BALDWIN
Practice Address - State:FL
Practice Address - Zip Code:32234-8027
Practice Address - Country:US
Practice Address - Phone:904-652-5425
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-03
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician