Provider Demographics
NPI:1467853556
Name:RUNNELS, CATHY ANNE (SLP)
Entity Type:Individual
Prefix:MS
First Name:CATHY
Middle Name:ANNE
Last Name:RUNNELS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13708 FAIRRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-5443
Mailing Address - Country:US
Mailing Address - Phone:301-879-1981
Mailing Address - Fax:
Practice Address - Street 1:13708 FAIRRIDGE DR
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-5443
Practice Address - Country:US
Practice Address - Phone:301-879-1981
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-09
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01053235Z00000X
VA2202003676235Z00000X
NC8338235Z00000X
DCSLP000244235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist