Provider Demographics
NPI:1346585544
Name:HENLINE, MAUREEN (MSCCC-SLP)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:
Last Name:HENLINE
Suffix:
Gender:F
Credentials:MSCCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3025 MULLINEAUX LN
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-2151
Mailing Address - Country:US
Mailing Address - Phone:410-418-9553
Mailing Address - Fax:
Practice Address - Street 1:3025 MULLINEAUX LN
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-2151
Practice Address - Country:US
Practice Address - Phone:410-418-9553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-29
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1647235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist