Provider Demographics
NPI:1285733659
Name:HAZELTON, CATHY A (MS, CCC-SP)
Entity type:Individual
Prefix:MS
First Name:CATHY
Middle Name:A
Last Name:HAZELTON
Suffix:
Gender:F
Credentials:MS, CCC-SP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 GREEN WOODS RD
Mailing Address - Street 2:
Mailing Address - City:PERU
Mailing Address - State:ME
Mailing Address - Zip Code:04290-3338
Mailing Address - Country:US
Mailing Address - Phone:207-562-8278
Mailing Address - Fax:207-369-0873
Practice Address - Street 1:425 GREEN WOODS RD
Practice Address - Street 2:
Practice Address - City:PERU
Practice Address - State:ME
Practice Address - Zip Code:04290-3338
Practice Address - Country:US
Practice Address - Phone:207-562-8278
Practice Address - Fax:207-369-0873
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MESP202235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist