Provider Demographics
NPI:1417427402
Name:MCCUSKER, KATIE
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:MCCUSKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11720 COLEMAN RD SW
Mailing Address - Street 2:
Mailing Address - City:FROSTBURG
Mailing Address - State:MD
Mailing Address - Zip Code:21532-3940
Mailing Address - Country:US
Mailing Address - Phone:301-689-0349
Mailing Address - Fax:
Practice Address - Street 1:16915 LOWER GEORGES CREEK RD SW
Practice Address - Street 2:
Practice Address - City:LONACONING
Practice Address - State:MD
Practice Address - Zip Code:21539-1100
Practice Address - Country:US
Practice Address - Phone:301-463-5751
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-03
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist