MEDICARE: CATHERINE MANECKE 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	SLP8319	AZ

General Provider Information

NPI Number	:	1801233895
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CATHERINE MANECKE CCC-SLP

Provider Business Mailing Address
First Line	:	13422 N 101ST WAY
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85260-7241
Country	:	US
Telephone Number	:	602-481-1959
Fax Number	:

Provider Business Practice Location Address
First Line	:	5110 E LAFAYETTE BLVD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85018-4433
Country	:	US
Telephone Number	:	480-484-2002
Fax Number	:

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

Provider Enumeration Date	:	05/30/2013
Last Update Date	:	08/25/2020

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Directions to “ CATHERINE MANECKE CCC-SLP” Practice Location

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