Provider Demographics
NPI:1811289341
Name:PIDEK, CATHERINE M (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:M
Last Name:PIDEK
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 1:52 JOHNSON HILL DR
Mailing Address - Street 2:
Mailing Address - City:WEAVERVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28787-7205
Mailing Address - Country:US
Mailing Address - Phone:828-626-2636
Mailing Address - Fax:828-626-2636
Practice Address - Street 1:52 JOHNSON HILL DR
Practice Address - Street 2:
Practice Address - City:WEAVERVILLE
Practice Address - State:NC
Practice Address - Zip Code:28787-7205
Practice Address - Country:US
Practice Address - Phone:828-626-2636
Practice Address - Fax:828-626-2636
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-02
Last Update Date:2011-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9101235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7413545Medicaid