Provider Demographics
NPI:1194809434
Name:GOURLEY, CATHY JEAN (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:CATHY
Middle Name:JEAN
Last Name:GOURLEY
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 S ROCKPORT RD
Mailing Address - Street 2:
Mailing Address - City:BOONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47601-9708
Mailing Address - Country:US
Mailing Address - Phone:812-897-8730
Mailing Address - Fax:812-897-8730
Practice Address - Street 1:1601 S ROCKPORT RD
Practice Address - Street 2:
Practice Address - City:BOONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47601-9708
Practice Address - Country:US
Practice Address - Phone:812-897-8730
Practice Address - Fax:812-897-8730
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22003247A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist