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Individual

DESIREE CAUDELL

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
3223 N OLIVER ST, WICHITA, KS 67220-2106
(316) 267-5437
(316) 267-3456
Mailing address
2637 E SPRING HILL CT, GODDARD, KS 67052-8594
(316) 755-5250

Taxonomy

Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1942649116
KS
Enumeration date
02/04/2016
Last updated
02/04/2016
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