Provider Demographics
NPI:1154466605
Name:OLEAN, CATHERINE
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:OLEAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RR 3 BOX 178B
Mailing Address - Street 2:
Mailing Address - City:HARVEYS LAKE
Mailing Address - State:PA
Mailing Address - Zip Code:18618-9404
Mailing Address - Country:US
Mailing Address - Phone:570-639-1369
Mailing Address - Fax:
Practice Address - Street 1:RR 3 BOX 178B
Practice Address - Street 2:
Practice Address - City:HARVEYS LAKE
Practice Address - State:PA
Practice Address - Zip Code:18618-9404
Practice Address - Country:US
Practice Address - Phone:570-639-1369
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL006358L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018817690004OtherMEDICAL ASSISTANCE