Provider Demographics
NPI:1952464018
Name:FALLER, CATHIE CAMPBELL (LIC SLP)
Entity Type:Individual
Prefix:MRS
First Name:CATHIE
Middle Name:CAMPBELL
Last Name:FALLER
Suffix:
Gender:F
Credentials:LIC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21241 VENTURA BLVD
Mailing Address - Street 2:#148
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364
Mailing Address - Country:US
Mailing Address - Phone:805-338-1072
Mailing Address - Fax:818-992-8745
Practice Address - Street 1:21241 VENTURA BLVD
Practice Address - Street 2:#148
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364
Practice Address - Country:US
Practice Address - Phone:805-338-1072
Practice Address - Fax:818-992-8745
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4915235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist