Basic Information
| Provider Information | |||||||||
| NPI: | 1174880652 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WITTEN | ||||||||
| FirstName: | CATHY | ||||||||
| MiddleName: | JOAN | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | SLP | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 504 KY RTE. 1107 | ||||||||
| Address2: | |||||||||
| City: | VAN LEAR | ||||||||
| State: | KY | ||||||||
| PostalCode: | 41265 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6067896793 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 625 JAMES S. TRIMBLE BLVD. | ||||||||
| Address2: | |||||||||
| City: | PAINTSVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 41240 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6067893511 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/20/2012 | ||||||||
| LastUpdateDate: | 04/20/2012 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 0038-A | KY | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.