Healthcare Provider Details

I. General information

NPI: 1497344113
Provider Name (Legal Business Name): SYKESVILLE SPEECH THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2021
Last Update Date: 01/17/2021
Certification Date: 01/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1522 LIBERTY RD STE B
SYKESVILLE MD
21784-6548
US

IV. Provider business mailing address

1814 FALLSTAFF CT
ELDERSBURG MD
21784-6274
US

V. Phone/Fax

Practice location:
  • Phone: 443-516-7752
  • Fax: 443-281-9025
Mailing address:
  • Phone: 443-452-7524
  • Fax: 443-281-9025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: NICOLE CLARKE
Title or Position: OWNER
Credential: M.S., CCC-SLP
Phone: 443-452-7524