Debra Jo Caulk

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

146.004322 Issued in IL

Practice address

1120 Village Rd
Crystal Lake, IL 60014-2908

Phone

(815) 788-3100

NPI assigned

Jan 2, 2025

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1735776000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1735776000000",
    "number": "1336958602",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4625 COYOTE LAKES CIR",
            "city": "LAKE IN THE HILLS",
            "state": "IL",
            "postal_code": "601566510",
            "telephone_number": "847-431-7283"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1120 VILLAGE RD",
            "city": "CRYSTAL LAKE",
            "state": "IL",
            "postal_code": "600142908",
            "telephone_number": "815-788-3100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CAULK",
        "first_name": "DEBRA",
        "middle_name": "JO",
        "name_prefix": "Mrs.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2025-01-02",
        "last_updated": "2025-01-02",
        "certification_date": "2025-01-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "IL",
            "license": "146.004322",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Speech-Language Pathologist in Crystal Lake, IL
• Providers in Crystal Lake, IL by specialty
• Speech-Language Pathologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.