Provider Demographics
NPI:1346919263
Name:MCGRUDER, CATHY
Entity Type:Individual
Prefix:
First Name:CATHY
Middle Name:
Last Name:MCGRUDER
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 1:129 WILLIE BURRELL DR
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MS
Mailing Address - Zip Code:39046-9550
Mailing Address - Country:US
Mailing Address - Phone:601-540-4781
Mailing Address - Fax:
Practice Address - Street 1:129 WILLIE BURRELL DR
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MS
Practice Address - Zip Code:39046-9550
Practice Address - Country:US
Practice Address - Phone:601-540-4781
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-13
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency