Provider Demographics
NPI:1902242811
Name:CAUCKWELL, TAMATHA L (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:TAMATHA
Middle Name:L
Last Name:CAUCKWELL
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:166 HAW RIVER RD
Mailing Address - Street 2:
Mailing Address - City:FLETCHER
Mailing Address - State:NC
Mailing Address - Zip Code:28732-6723
Mailing Address - Country:US
Mailing Address - Phone:916-803-7303
Mailing Address - Fax:
Practice Address - Street 1:166 HAW RIVER RD
Practice Address - Street 2:
Practice Address - City:FLETCHER
Practice Address - State:NC
Practice Address - Zip Code:28732-6723
Practice Address - Country:US
Practice Address - Phone:916-803-7303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-18
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP 17330235Z00000X
NVSP 1388235Z00000X
NC12581235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist