Provider Demographics
NPI:1891876330
Name:SALCICCIA, CATHY ELLEN (MS CCC SLP)
Entity Type:Individual
Prefix:MS
First Name:CATHY
Middle Name:ELLEN
Last Name:SALCICCIA
Suffix:
Gender:F
Credentials:MS CCC SLP
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1633
Mailing Address - Street 2:
Mailing Address - City:GLOUCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01931-1633
Mailing Address - Country:US
Mailing Address - Phone:978-282-9978
Mailing Address - Fax:
Practice Address - Street 1:85 EASTERN AVENUE
Practice Address - Street 2:SUITE 212
Practice Address - City:GLOUCESTER
Practice Address - State:MA
Practice Address - Zip Code:01930
Practice Address - Country:US
Practice Address - Phone:978-282-8210
Practice Address - Fax:978-282-1144
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3350235Z00000X
FLSA2456235Z00000X
NH0699235Z00000X
NY0037171235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA767827OtherTUFTS HEALTH PLAN
MA0360171Medicaid
MASP0067OtherBLUE CROSS BLUE SHIELD