Provider Demographics
NPI:1366189714
Name:ZACZEK, CATHERINE (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:ZACZEK
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 BRUSH MILL TRL
Mailing Address - Street 2:
Mailing Address - City:HIGGANUM
Mailing Address - State:CT
Mailing Address - Zip Code:06441-4091
Mailing Address - Country:US
Mailing Address - Phone:860-916-5847
Mailing Address - Fax:
Practice Address - Street 1:600 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-5151
Practice Address - Country:US
Practice Address - Phone:860-347-3315
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-17
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT006074235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT006074OtherSTATE OF CONNECTICUT
14305930OtherAMERICAN SPEECH-LANGUAGE HEARING ASSOCIATION