Healthcare Provider Details

I. General information

NPI: 1558929489
Provider Name (Legal Business Name): SHARON KUO PHD CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2019
Last Update Date: 06/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2772 LIGHTHOUSE PT E UNIT 403
BALTIMORE MD
21224-5048
US

IV. Provider business mailing address

2772 LIGHTHOUSE PT E UNIT 403
BALTIMORE MD
21224-5048
US

V. Phone/Fax

Practice location:
  • Phone: 781-354-2604
  • Fax:
Mailing address:
  • Phone: 781-354-2604
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number06610
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: