Provider Demographics
NPI:1144900630
Name:CORREA, CATHY JEAN (SLP)
Entity type:Individual
Prefix:
First Name:CATHY
Middle Name:JEAN
Last Name:CORREA
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8179 PINOSA ST
Mailing Address - Street 2:
Mailing Address - City:NAVARRE
Mailing Address - State:FL
Mailing Address - Zip Code:32566-9170
Mailing Address - Country:US
Mailing Address - Phone:912-271-1358
Mailing Address - Fax:
Practice Address - Street 1:8179 PINOSA ST
Practice Address - Street 2:
Practice Address - City:NAVARRE
Practice Address - State:FL
Practice Address - Zip Code:32566-9170
Practice Address - Country:US
Practice Address - Phone:912-271-1358
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-20
Last Update Date:2024-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH24954101YM0800X
FL21496235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist