MEDICARE: COREY ANN CATHEY CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	2013024711	MO

General Provider Information

NPI Number	:	1083078687
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COREY ANN CATHEY CCC-SLP

Provider Business Mailing Address
First Line	:	4603 JOHN GARRY DR STE 10
Second Line	:
City	:	COLUMBIA
State	:	MO
Zip	:	65203-6834
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4603 JOHN GARRY DR STE 10
Second Line	:
City	:	COLUMBIA
State	:	MO
Zip	:	65203-6834
Country	:	US
Telephone Number	:	573-777-8783
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/09/2016
Last Update Date	:	04/09/2016

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Directions to “ COREY ANN CATHEY CCC-SLP” Practice Location

Language	Start Address	Practice Location

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