Provider Demographics
NPI:1730582149
Name:MCIVOR, CATHERINE MARY (SLPA)
Entity type:Individual
Prefix:MRS
First Name:CATHERINE
Middle Name:MARY
Last Name:MCIVOR
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4870 N LITCHFIELD RD STE 101
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD PARK
Mailing Address - State:AZ
Mailing Address - Zip Code:85340-5041
Mailing Address - Country:US
Mailing Address - Phone:623-935-6040
Mailing Address - Fax:623-935-6046
Practice Address - Street 1:4870 N LITCHFIELD RD STE 101
Practice Address - Street 2:
Practice Address - City:LITCHFIELD PARK
Practice Address - State:AZ
Practice Address - Zip Code:85340-5041
Practice Address - Country:US
Practice Address - Phone:623-935-6040
Practice Address - Fax:623-935-6046
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-29
Last Update Date:2014-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA9022305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service