MEDICARE: CATHERINE ADDY 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	7101004786	MI

General Provider Information

NPI Number	:	1619531274
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CATHERINE ADDY CCC-SLP

Provider Business Mailing Address
First Line	:	12800 ESCANABA DR STE C
Second Line	:
City	:	DEWITT
State	:	MI
Zip	:	48820-8680
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	701 SNOW RD STE A
Second Line	:
City	:	LANSING
State	:	MI
Zip	:	48917-4087
Country	:	US
Telephone Number	:	517-323-0593
Fax Number	:	518-323-0002

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

Provider Enumeration Date	:	04/29/2019
Last Update Date	:	04/29/2019

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Directions to “ CATHERINE ADDY CCC-SLP” Practice Location

Language	Start Address	Practice Location

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