Healthcare Provider Details

I. General information

NPI: 1740690809
Provider Name (Legal Business Name): CATHY DAMEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2014
Last Update Date: 04/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 STRINGTOWN RD
EVANSVILLE IN
47711-4522
US

IV. Provider business mailing address

1900 STRINGTOWN RD
EVANSVILLE IN
47711-4522
US

V. Phone/Fax

Practice location:
  • Phone: 812-490-2826
  • Fax:
Mailing address:
  • Phone: 812-490-2826
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-14-15252
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: