Healthcare Provider Details

I. General information

NPI: 1427521210
Provider Name (Legal Business Name): KATHERINE JOANNE CUCCIA WEEKS SLP-CCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2019
Last Update Date: 01/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2170 W IRONWOOD CENTER DR
COEUR D ALENE ID
83814-2606
US

IV. Provider business mailing address

507 S RIVERSIDE HARBOR DR
POST FALLS ID
83854-6875
US

V. Phone/Fax

Practice location:
  • Phone: 208-667-1988
  • Fax:
Mailing address:
  • Phone: 951-836-8477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP-3357
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: