MEDICARE: CATHERINE K BACON M.A.

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	1317	AZ

General Provider Information

NPI Number	:	1699833863
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CATHERINE K BACON M.A.

Provider Business Mailing Address
First Line	:	PO BOX 870102
Second Line	:	ARIZONA STATE UNIVERSITY
City	:	TEMPE
State	:	AZ
Zip	:	85287-0102
Country	:	US
Telephone Number	:	480-965-5475
Fax Number	:

Provider Business Practice Location Address
First Line	:	SPEECH HEARING CLINIC
Second Line	:	ARIZONA STATE UNIVERSITY
City	:	TEMPE
State	:	AZ
Zip	:	85287-0102
Country	:	US
Telephone Number	:	480-965-5475
Fax Number	:

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

Provider Enumeration Date	:	12/04/2006
Last Update Date	:	07/08/2007

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