Provider Demographics
NPI:1609988237
Name:AUSTELLE, CATHRYN MOSS (MA, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:CATHRYN
Middle Name:MOSS
Last Name:AUSTELLE
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:243 MARSH OAKS DR
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-6857
Mailing Address - Country:US
Mailing Address - Phone:843-568-6580
Mailing Address - Fax:
Practice Address - Street 1:243 MARSH OAKS DR
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-6857
Practice Address - Country:US
Practice Address - Phone:843-568-6580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3519235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSA0512Medicaid