Provider Demographics
NPI:1124449418
Name:WOIDTKE, CATHERINE RAE (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:CATHERINE
Middle Name:RAE
Last Name:WOIDTKE
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 1:7418 LONG POINT DR NW
Mailing Address - Street 2:
Mailing Address - City:WILLIAMS
Mailing Address - State:MN
Mailing Address - Zip Code:56686-4501
Mailing Address - Country:US
Mailing Address - Phone:218-783-7366
Mailing Address - Fax:
Practice Address - Street 1:7418 LONG POINT DR NW
Practice Address - Street 2:
Practice Address - City:WILLIAMS
Practice Address - State:MN
Practice Address - Zip Code:56686-4501
Practice Address - Country:US
Practice Address - Phone:218-783-7366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-03
Last Update Date:2014-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN445495235Z00000X
ND000029956235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist