Provider Demographics
NPI:1942910344
Name:CALDWELL, ISHA (LADC, LPCC)
Entity type:Individual
Prefix:
First Name:ISHA
Middle Name:
Last Name:CALDWELL
Suffix:
Gender:
Credentials:LADC, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106167 N 3800 RD
Mailing Address - Street 2:
Mailing Address - City:OKEMAH
Mailing Address - State:OK
Mailing Address - Zip Code:74859-5178
Mailing Address - Country:US
Mailing Address - Phone:612-460-7696
Mailing Address - Fax:
Practice Address - Street 1:1404 14TH AVE N
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55411-3111
Practice Address - Country:US
Practice Address - Phone:612-460-7693
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-28
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN305991101YA0400X
MN4641101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)