Provider Demographics
NPI:1942320981
Name:BATCHELOR, CATHY SMITH (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CATHY
Middle Name:SMITH
Last Name:BATCHELOR
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2629 COUNTRY SIDE DR
Mailing Address - Street 2:
Mailing Address - City:FLEMING ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32003-4953
Mailing Address - Country:US
Mailing Address - Phone:904-215-1715
Mailing Address - Fax:
Practice Address - Street 1:2629 COUNTRY SIDE DR
Practice Address - Street 2:
Practice Address - City:FLEMING ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32003-4953
Practice Address - Country:US
Practice Address - Phone:904-215-1715
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-31
Last Update Date:2012-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA10489235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist