Provider Demographics
NPI:1861068272
Name:PODEMSKI, CAITLIN ANNE (MT-BC)
Entity type:Individual
Prefix:
First Name:CAITLIN
Middle Name:ANNE
Last Name:PODEMSKI
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 GRAND CANYON DR APT 2
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53705-4254
Mailing Address - Country:US
Mailing Address - Phone:815-275-5157
Mailing Address - Fax:
Practice Address - Street 1:315 E 5TH ST # 202
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50703-4757
Practice Address - Country:US
Practice Address - Phone:815-275-5157
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-27
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist