Provider Demographics
NPI:1871200600
Name:BOLEN, CAITLYN JOY
Entity type:Individual
Prefix:
First Name:CAITLYN
Middle Name:JOY
Last Name:BOLEN
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 1:600 E COUNTY HIGHWAY B
Mailing Address - Street 2:
Mailing Address - City:SHELL LAKE
Mailing Address - State:WI
Mailing Address - Zip Code:54871-8754
Mailing Address - Country:US
Mailing Address - Phone:715-468-2841
Mailing Address - Fax:715-468-2374
Practice Address - Street 1:600 E COUNTY HIGHWAY B
Practice Address - Street 2:
Practice Address - City:SHELL LAKE
Practice Address - State:WI
Practice Address - Zip Code:54871-8754
Practice Address - Country:US
Practice Address - Phone:715-468-2841
Practice Address - Fax:715-468-2374
Is Sole Proprietor?:No
Enumeration Date:2022-11-01
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8127-226101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor