Provider Demographics
NPI:1235753070
Name:OLIVEROS, CATHY
Entity Type:Individual
Prefix:
First Name:CATHY
Middle Name:
Last Name:OLIVEROS
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 1:684 MT TABOR RD
Mailing Address - Street 2:
Mailing Address - City:STAUNTON
Mailing Address - State:VA
Mailing Address - Zip Code:24401-5903
Mailing Address - Country:US
Mailing Address - Phone:214-926-4522
Mailing Address - Fax:
Practice Address - Street 1:684 MT TABOR RD
Practice Address - Street 2:
Practice Address - City:STAUNTON
Practice Address - State:VA
Practice Address - Zip Code:24401-5903
Practice Address - Country:US
Practice Address - Phone:214-926-4522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-07
Last Update Date:2020-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX112692235Z00000X
VA2202009526235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist