Provider Demographics
NPI:1629157730
Name:LANGEVIN, CATHLEEN MARIE (SLP)
Entity Type:Individual
Prefix:MS
First Name:CATHLEEN
Middle Name:MARIE
Last Name:LANGEVIN
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 1:5659 STADIUM DR
Mailing Address - Street 2:BUILDING A
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-1932
Mailing Address - Country:US
Mailing Address - Phone:269-372-0436
Mailing Address - Fax:
Practice Address - Street 1:5659 STADIUM DR
Practice Address - Street 2:BUILDING A
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-1932
Practice Address - Country:US
Practice Address - Phone:269-372-0436
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2019-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242.000245235Z00000X
MI12130013235Z00000X
NC8681235Z00000X
MI7101000902235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist