Healthcare Provider Details

I. General information

NPI: 1861965311
Provider Name (Legal Business Name): MIJIN PAIK CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2019
Last Update Date: 04/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9701 VEIRS DR
ROCKVILLE MD
20850-3414
US

IV. Provider business mailing address

9701 VEIRS DR
ROCKVILLE MD
20850-3414
US

V. Phone/Fax

Practice location:
  • Phone: 301-424-9560
  • Fax:
Mailing address:
  • Phone: 202-525-5738
  • Fax: 855-232-8604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP001306
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number08944
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: