Provider Demographics
NPI:1518731553
Name:LONG, CATHERINE R (MS SLP)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:R
Last Name:LONG
Suffix:
Gender:F
Credentials:MS SLP
Other - Prefix:
Other - First Name:CATHERIN
Other - Middle Name:R
Other - Last Name:ROCKWELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS SLP
Mailing Address - Street 1:3330 COUNTRY SQUARE DR APT 824
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75006-6722
Mailing Address - Country:US
Mailing Address - Phone:214-771-5675
Mailing Address - Fax:
Practice Address - Street 1:3330 COUNTRY SQUARE DR APT 824
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75006-6722
Practice Address - Country:US
Practice Address - Phone:214-771-5675
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-09
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX121839235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty