Provider Demographics
NPI:1457624918
Name:MIX, CATHERINE FRANCIS (MS, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:CATHERINE
Middle Name:FRANCIS
Last Name:MIX
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1417 BROOKWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48503-2750
Mailing Address - Country:US
Mailing Address - Phone:810-424-0506
Mailing Address - Fax:
Practice Address - Street 1:1417 BROOKWOOD AVE
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48503-2750
Practice Address - Country:US
Practice Address - Phone:810-424-0506
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-14
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIASHA12077548235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist