Active NPI
Caitlin M Speck, PSYD
- Clinical Psychologist
- Bend, OR
National Provider Identifier
1487129557
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 3003
- Practice address
- 376 SW Bluff Dr Ste 5
Bend, OR 97702-1399 - Phone
- (458) 281-0413
- NPI assigned
- Oct 4, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Health Psychologist | 103TH0004X | 3003 | OR | |
| Clinical Psychologist | 103TC0700X | 3003 | OR | Primary |
Addresses
Primary practice location
376 SW Bluff Dr Ste 5
Bend, OR 97702-1399
Mailing address
376 SW Bluff Dr Ste 5
Bend, OR 97702-1399
Phone (458) 281-0413
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Apr 1, 2023 through Apr 1, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3003 | OR | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mind Health Consulting LLC | Current | Accepting new patients |
Locations
376 SW Bluff Dr
Ste 5
Bend, OR 97702
Phone (458) 281-0413
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Mental Health Clinic/Center (Including Community Mental Health Center)
- Bend, OR
- NPI 1104553999
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1538611200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1667952000000",
"number": "1487129557",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "376 SW BLUFF DR STE 5",
"city": "BEND",
"state": "OR",
"postal_code": "977021399",
"telephone_number": "458-281-0413"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "376 SW BLUFF DR STE 5",
"city": "BEND",
"state": "OR",
"postal_code": "977021399",
"telephone_number": "458-281-0413"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SPECK",
"first_name": "CAITLIN",
"middle_name": "M",
"credential": "PSYD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-10-04",
"last_updated": "2022-11-09",
"certification_date": "2022-11-09",
"status": "A"
},
"taxonomies": [
{
"code": "103TH0004X",
"taxonomy_group": "",
"desc": "Psychologist, Health",
"state": "OR",
"license": "3003",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "OR",
"license": "3003",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bend, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.