Provider Demographics
NPI:1184024929
Name:MAHALICK, BRITTANY KIANNA (MS)
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:KIANNA
Last Name:MAHALICK
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:BRITTANY
Other - Middle Name:KIANNA
Other - Last Name:CLEMENT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:207 PERRY PKWY
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20877-2142
Mailing Address - Country:US
Mailing Address - Phone:312-909-6369
Mailing Address - Fax:
Practice Address - Street 1:207 PERRY PKWY
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-2142
Practice Address - Country:US
Practice Address - Phone:312-909-6369
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-29
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL246.000195170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS