Basic Information
| Provider Information | |||||||||
| NPI: | 1437891900 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STURR | ||||||||
| FirstName: | CAITLIN | ||||||||
| MiddleName: | BLACKMER | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 776982 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606776982 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2316722119 | ||||||||
| FaxNumber: | 3134327759 | ||||||||
| Practice Location | |||||||||
| Address1: | 1223 MERCY DR | ||||||||
| Address2: | |||||||||
| City: | MUSKEGON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 494441829 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2316727307 | ||||||||
| FaxNumber: | 2316723178 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/13/2022 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/21/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 6801114991 | MI | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 1437891900 | 05 | MI | MEDICAID |