Healthcare Provider Details

I. General information

NPI: 1285938902
Provider Name (Legal Business Name): PATTI JANE CAUDILL CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PATTI BAILEY

II. Dates (important events)

Enumeration Date: 01/10/2011
Last Update Date: 08/27/2021
Certification Date: 08/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6569 N CHARLES ST STE 401
BALTIMORE MD
21204-5834
US

IV. Provider business mailing address

PO BOX 631568
BALTIMORE MD
21263-1568
US

V. Phone/Fax

Practice location:
  • Phone: 443-849-2087
  • Fax: 443-849-2649
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number04786
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: