Provider Demographics
NPI:1174880652
Name:WITTEN, CATHY JOAN (SLP)
Entity type:Individual
Prefix:MRS
First Name:CATHY
Middle Name:JOAN
Last Name:WITTEN
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 KY RTE. 1107
Mailing Address - Street 2:
Mailing Address - City:VAN LEAR
Mailing Address - State:KY
Mailing Address - Zip Code:41265
Mailing Address - Country:US
Mailing Address - Phone:606-789-6793
Mailing Address - Fax:
Practice Address - Street 1:625 JAMES S. TRIMBLE BLVD.
Practice Address - Street 2:
Practice Address - City:PAINTSVILLE
Practice Address - State:KY
Practice Address - Zip Code:41240
Practice Address - Country:US
Practice Address - Phone:606-789-3511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-20
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0038-A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist