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General NPI Number Information
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NPI Number | 1558576710
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Entity Type | Individual
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Provider Name | KATHERINE GALLO GLICK MA, CCC-SLP/L
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Gender | Female
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Dates
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Enumeration Date | 05/11/2007
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Last Update Date | 11/14/2011
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Provider Practice Location Address
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Address Line | 7540 SAWMILL PARKWAY SUITE A-2
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City | POWELL
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State | OH
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Zip | 43065-9845
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Country | US
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Telephone | 614-570-7252
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Fax | 614-840-9310
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Provider Business Mailing Address
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Address Line | 7540 SAWMILL PARKWAY SUITE A-2
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City | POWELL
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State | OH
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Zip | 43065-9845
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Country | US
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Telephone | 614-570-7252
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Fax | 614-840-9310
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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 | SP 8666
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | ASHA 12126404
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License Number State | OH
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