Provider Demographics
NPI:1346373552
Name:TIJERINA, OLIVIA MARISA (MSCCC)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:MARISA
Last Name:TIJERINA
Suffix:
Gender:F
Credentials:MSCCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8512 ELLICOTT VIEW RD
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-6080
Mailing Address - Country:US
Mailing Address - Phone:410-461-5691
Mailing Address - Fax:410-560-0345
Practice Address - Street 1:10632 LITTLE PATUXENT PKWY
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3273
Practice Address - Country:US
Practice Address - Phone:410-740-0300
Practice Address - Fax:410-740-0302
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD02226235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist