Provider Demographics
NPI:1710378138
Name:DALEY, CATHLENE (MS CF-SLP)
Entity Type:Individual
Prefix:
First Name:CATHLENE
Middle Name:
Last Name:DALEY
Suffix:
Gender:F
Credentials:MS CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1500
Mailing Address - Street 2:243 WOODROW WILSON AVE
Mailing Address - City:FISHERSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22939-1500
Mailing Address - Country:US
Mailing Address - Phone:540-332-7975
Mailing Address - Fax:540-332-7288
Practice Address - Street 1:243 WOODROW WILSON AVE
Practice Address - Street 2:
Practice Address - City:FISHERSVILLE
Practice Address - State:VA
Practice Address - Zip Code:22939-1500
Practice Address - Country:US
Practice Address - Phone:540-332-7087
Practice Address - Fax:540-332-7288
Is Sole Proprietor?:No
Enumeration Date:2015-02-06
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202007251235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1629049143Medicaid
VA494515Medicare UPIN