Provider Demographics
NPI:1073858247
Name:KATKO, CYNTHIA (MCD, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:KATKO
Suffix:
Gender:F
Credentials:MCD, 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:PO BOX 624
Mailing Address - Street 2:100 PROVIDENCE RD
Mailing Address - City:LAMAR
Mailing Address - State:SC
Mailing Address - Zip Code:29069-0624
Mailing Address - Country:US
Mailing Address - Phone:843-326-1000
Mailing Address - Fax:
Practice Address - Street 1:100 PROVIDENCE ROAD
Practice Address - Street 2:
Practice Address - City:LAMAR
Practice Address - State:SC
Practice Address - Zip Code:29069
Practice Address - Country:US
Practice Address - Phone:843-326-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-29
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3542235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist