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1093072530 NPI number — HEATHER DANIELLE MCCORMICK M.S., CCC-SLP, CLC

NPI Number: 1093072530
Health Care Provider/Practitioner: HEATHER DANIELLE MCCORMICK M.S., CCC-SLP, CLC

Information about “1093072530” NPI (HEATHER DANIELLE MCCORMICK M.S., CCC-SLP, CLC) exists in 1093072530 in HTML format HTML  |  1093072530 in plain Text format TXT  |  1093072530 in PDF (Portable Document Format) PDF  |  1093072530 in an XML format XML  formats.

NPI Number : 1093072530 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1093072530",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "MCCORMICK",
    "FirstName": "HEATHER",
    "MiddleName": "DANIELLE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "M.S., CCC-SLP, CLC",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "3230 GREENWAY DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "ELLICOTT CITY",
    "MailingAddressStateName": "MD",
    "MailingAddressPostalCode": "21042-2418",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "443-923-1842",
    "MailingAddressFaxNumber": "443-923-1875",
    "FirstLinePracticeLocationAddress": "707 N BROADWAY",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "BALTIMORE",
    "PracticeLocationAddressStateName": "MD",
    "PracticeLocationAddressPostalCode": "21205-1832",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "443-923-9200",
    "PracticeLocationAddressFaxNumber": "443-923-1875",
    "EnumerationDate": "04/23/2012",
    "LastUpdateDate": "10/24/2022",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "235Z00000X",
        "TaxonomyName": "Speech-Language Pathologist",
        "LicenseNumber": "06851",
        "LicenseNumberStateCode": "MD",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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