Provider Demographics
NPI:1942258090
Name:CHILDERS, CATHERINE BAILEY (MSP, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:CATHERINE
Middle Name:BAILEY
Last Name:CHILDERS
Suffix:
Gender:F
Credentials:MSP, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 HIDDEN HILL RD
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:SC
Mailing Address - Zip Code:29379-9105
Mailing Address - Country:US
Mailing Address - Phone:864-427-9213
Mailing Address - Fax:
Practice Address - Street 1:113 HIDDEN HILL RD
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:SC
Practice Address - Zip Code:29379-9105
Practice Address - Country:US
Practice Address - Phone:864-427-9213
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3269235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSAO645Medicaid