Provider Demographics
NPI:1043580210
Name:CATILLAZ, TABER CARPENTER (MED CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:TABER
Middle Name:CARPENTER
Last Name:CATILLAZ
Suffix:
Gender:F
Credentials:MED CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 N JEFFERSON ST UPPR LEVEL
Mailing Address - Street 2:
Mailing Address - City:STAUNTON
Mailing Address - State:VA
Mailing Address - Zip Code:24401-3341
Mailing Address - Country:US
Mailing Address - Phone:757-630-3126
Mailing Address - Fax:
Practice Address - Street 1:37 JACKSON ST
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-4807
Practice Address - Country:US
Practice Address - Phone:757-630-3126
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-05
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202006546235Z00000X
NY022382-01235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist