Provider Demographics
NPI:1144540592
Name:MANICKE, CATHERINE (MA)
Entity type:Individual
Prefix:MS
First Name:CATHERINE
Middle Name:
Last Name:MANICKE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 ROUNDHOUSE PLZ STE 202-203
Mailing Address - Street 2:
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060-4401
Mailing Address - Country:US
Mailing Address - Phone:413-586-1945
Mailing Address - Fax:413-586-1946
Practice Address - Street 1:1 ROUNDHOUSE PLZ STE 202-203
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-4401
Practice Address - Country:US
Practice Address - Phone:413-586-1945
Practice Address - Fax:413-586-1946
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-08
Last Update Date:2010-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7491235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist