Provider Demographics
NPI:1922188804
Name:GARNER, CATHLEEN M
Entity Type:Individual
Prefix:
First Name:CATHLEEN
Middle Name:M
Last Name:GARNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CATHLEEN
Other - Middle Name:MARIE
Other - Last Name:CALLAHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 406153
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-1876
Mailing Address - Country:US
Mailing Address - Phone:989-362-8196
Mailing Address - Fax:989-362-0967
Practice Address - Street 1:110 BEECH ST
Practice Address - Street 2:SUITE C
Practice Address - City:TAWAS CITY
Practice Address - State:MI
Practice Address - Zip Code:48763-8314
Practice Address - Country:US
Practice Address - Phone:989-362-8196
Practice Address - Fax:989-362-0967
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI3501004427231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1922188804Medicaid
MI1922188804Medicaid