Provider Demographics
NPI:1629366273
Name:MANCUSO-SALAMUN, CATHERINE (MS/CCC)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:MANCUSO-SALAMUN
Suffix:
Gender:F
Credentials:MS/CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 HALTON CIR
Mailing Address - Street 2:
Mailing Address - City:SEFFNER
Mailing Address - State:FL
Mailing Address - Zip Code:33584-4157
Mailing Address - Country:US
Mailing Address - Phone:811-372-7614
Mailing Address - Fax:
Practice Address - Street 1:218 HALTON CIR
Practice Address - Street 2:
Practice Address - City:SEFFNER
Practice Address - State:FL
Practice Address - Zip Code:33584-4157
Practice Address - Country:US
Practice Address - Phone:811-372-7614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-18
Last Update Date:2011-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 2554235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist