Provider Demographics
NPI:1730918079
Name:CANNON, CATREECE
Entity type:Individual
Prefix:MRS
First Name:CATREECE
Middle Name:
Last Name:CANNON
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:CATREECE
Other - Middle Name:
Other - Last Name:TATUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2007 WINDMILL WAY
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45240-3343
Mailing Address - Country:US
Mailing Address - Phone:513-679-0470
Mailing Address - Fax:
Practice Address - Street 1:1251 NILLES RD STE 5
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014-7205
Practice Address - Country:US
Practice Address - Phone:513-939-0300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-26
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker