MEDICARE: CATHY L WILLEN AUD

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	231H00000X	Audiologist	102600	MO

General Provider Information

NPI Number	:	1912900762
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CATHY L WILLEN AUD

Provider Business Mailing Address
First Line	:	262 S MOUNT AUBURN RD
Second Line	:
City	:	CAPE GIRARDEAU
State	:	MO
Zip	:	63703-4918
Country	:	US
Telephone Number	:	573-651-3404
Fax Number	:	573-651-0035

Provider Business Practice Location Address
First Line	:	262 S MOUNT AUBURN RD
Second Line	:
City	:	CAPE GIRARDEAU
State	:	MO
Zip	:	63703-4918
Country	:	US
Telephone Number	:	573-651-3404
Fax Number	:	573-651-0035

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

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	07/09/2007

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Directions to “ CATHY L WILLEN AUD” Practice Location

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