Provider Demographics
NPI:1235769886
Name:TICKLE, CATHERINE (HAD)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:TICKLE
Suffix:
Gender:F
Credentials:HAD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2403 N UNION BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-1173
Mailing Address - Country:US
Mailing Address - Phone:719-634-6260
Mailing Address - Fax:719-634-1298
Practice Address - Street 1:2403 N UNION BLVD STE 101
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-1173
Practice Address - Country:US
Practice Address - Phone:719-634-6260
Practice Address - Fax:719-634-1298
Is Sole Proprietor?:No
Enumeration Date:2020-01-23
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0000281237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist