Provider Demographics
NPI:1972288454
Name:DEAN, CATHRYN EMILY (MED)
Entity type:Individual
Prefix:
First Name:CATHRYN
Middle Name:EMILY
Last Name:DEAN
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1160 GRIMES BRIDGE RD STE B
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-3900
Mailing Address - Country:US
Mailing Address - Phone:770-539-0713
Mailing Address - Fax:
Practice Address - Street 1:1160 GRIMES BRIDGE RD STE B
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-3900
Practice Address - Country:US
Practice Address - Phone:470-423-9477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-21
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPCET003855235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist