MEDICARE: CATHERINE MCMULLEN PRESTON

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	1979	NC

General Provider Information

NPI Number	:	1699972141
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CATHERINE MCMULLEN PRESTON

Provider Business Mailing Address
First Line	:	3418 COTTONWOOD DR
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27707-2426
Country	:	US
Telephone Number	:	919-489-2105
Fax Number	:

Provider Business Practice Location Address
First Line	:	1515 W PETTIGREW ST
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27705-4821
Country	:	US
Telephone Number	:	919-416-5995
Fax Number	:

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

Provider Enumeration Date	:	06/28/2007
Last Update Date	:	07/08/2007

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Directions to “ CATHERINE MCMULLEN PRESTON ” Practice Location

Language	Start Address	Practice Location

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