Provider Demographics
NPI:1285871434
Name:REILLY, CATHLEEN R (SLP)
Entity type:Individual
Prefix:
First Name:CATHLEEN
Middle Name:R
Last Name:REILLY
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 N COUNTRY CLUB DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-3723
Mailing Address - Country:US
Mailing Address - Phone:585-455-5846
Mailing Address - Fax:
Practice Address - Street 1:47 N COUNTRY CLUB DR
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-3723
Practice Address - Country:US
Practice Address - Phone:585-455-5846
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-09
Last Update Date:2009-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003500235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist