Provider Demographics
NPI:1144538547
Name:DELOACH, CATHY WALL (SPEECH PATHOLOGIST)
Entity type:Individual
Prefix:MRS
First Name:CATHY
Middle Name:WALL
Last Name:DELOACH
Suffix:
Gender:F
Credentials:SPEECH PATHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:463 BAKER BLVD
Mailing Address - Street 2:P O BOX 755
Mailing Address - City:ESTILL
Mailing Address - State:SC
Mailing Address - Zip Code:29918-3365
Mailing Address - Country:US
Mailing Address - Phone:803-942-2374
Mailing Address - Fax:
Practice Address - Street 1:463 BAKER BLVD
Practice Address - Street 2:
Practice Address - City:ESTILL
Practice Address - State:SC
Practice Address - Zip Code:29918-3365
Practice Address - Country:US
Practice Address - Phone:803-942-2374
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-20
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4404235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist