Provider Demographics
NPI:1023453636
Name:WEISS, CATHERINE LUCILLE
Entity type:Individual
Prefix:MRS
First Name:CATHERINE
Middle Name:LUCILLE
Last Name:WEISS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4475 GATLIN KNOLL LN
Mailing Address - Street 2:
Mailing Address - City:CLEMMONS
Mailing Address - State:NC
Mailing Address - Zip Code:27012-7711
Mailing Address - Country:US
Mailing Address - Phone:336-766-5656
Mailing Address - Fax:
Practice Address - Street 1:4475 GATLIN KNOLL LN
Practice Address - Street 2:
Practice Address - City:CLEMMONS
Practice Address - State:NC
Practice Address - Zip Code:27012-7711
Practice Address - Country:US
Practice Address - Phone:336-766-5656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-09
Last Update Date:2013-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3304235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist