Provider Demographics
NPI:1437469491
Name:MICHELSON, CATHERINE MARKLEY
Entity Type:Individual
Prefix:MRS
First Name:CATHERINE
Middle Name:MARKLEY
Last Name:MICHELSON
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:PO BOX 190
Mailing Address - Street 2:
Mailing Address - City:RED CREEK
Mailing Address - State:NY
Mailing Address - Zip Code:13143-0190
Mailing Address - Country:US
Mailing Address - Phone:315-754-2100
Mailing Address - Fax:
Practice Address - Street 1:6624 SOUTH ST
Practice Address - Street 2:
Practice Address - City:RED CREEK
Practice Address - State:NY
Practice Address - Zip Code:13143-9510
Practice Address - Country:US
Practice Address - Phone:315-754-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-08
Last Update Date:2010-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004508-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist