Provider Demographics
NPI:1184868127
Name:REIGLE, CATHLEEN M (AUD CCC-A)
Entity Type:Individual
Prefix:
First Name:CATHLEEN
Middle Name:M
Last Name:REIGLE
Suffix:
Gender:F
Credentials:AUD CCC-A
Other - Prefix:
Other - First Name:CATHLEEN
Other - Middle Name:M
Other - Last Name:BRUECKNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD CCC-A
Mailing Address - Street 1:PO BOX 99213
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76199-0213
Mailing Address - Country:US
Mailing Address - Phone:682-885-3622
Mailing Address - Fax:682-885-3936
Practice Address - Street 1:1919 8TH AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76110-1358
Practice Address - Country:US
Practice Address - Phone:682-885-4063
Practice Address - Fax:682-885-1878
Is Sole Proprietor?:No
Enumeration Date:2009-04-21
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI535-156231H00000X
TX80547231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX324907002Medicaid
TX324907003/HA1Medicaid
TX324907001Medicaid
TX324907004/HA1 CSNMedicaid