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General NPI Number Information
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NPI Number | 1093072530
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Entity Type | Individual
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Provider Name | HEATHER DANIELLE MCCORMICK M.S., CCC-SLP, CLC
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Gender | Female
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Dates
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Enumeration Date | 04/23/2012
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Last Update Date | 10/24/2022
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Provider Practice Location Address
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Address Line | 707 N BROADWAY
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City | BALTIMORE
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State | MD
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Zip | 21205-1832
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Country | US
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Telephone | 443-923-9200
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Fax | 443-923-1875
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Provider Business Mailing Address
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Address Line | 3230 GREENWAY DR
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City | ELLICOTT CITY
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State | MD
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Zip | 21042-2418
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Country | US
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Telephone | 443-923-1842
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Fax | 443-923-1875
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 06851
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License Number State | MD
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