Provider Demographics
NPI:1477735553
Name:SHIDLOVSKY, CATHY MARIE (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CATHY
Middle Name:MARIE
Last Name:SHIDLOVSKY
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 EAST ST
Mailing Address - Street 2:
Mailing Address - City:CLAREMONT
Mailing Address - State:NH
Mailing Address - Zip Code:03743-3117
Mailing Address - Country:US
Mailing Address - Phone:603-543-0343
Mailing Address - Fax:
Practice Address - Street 1:47 EAST ST
Practice Address - Street 2:
Practice Address - City:CLAREMONT
Practice Address - State:NH
Practice Address - Zip Code:03743-3117
Practice Address - Country:US
Practice Address - Phone:603-543-0343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-30
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0289235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist