Provider Demographics
NPI:1467078824
Name:PIZZALA, ADELINE SMITH (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ADELINE
Middle Name:SMITH
Last Name:PIZZALA
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:ADDI
Other - Middle Name:
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:21 OLD FORGE GARTH
Mailing Address - Street 2:
Mailing Address - City:SPARKS GLENCOE
Mailing Address - State:MD
Mailing Address - Zip Code:21152-8801
Mailing Address - Country:US
Mailing Address - Phone:575-640-1091
Mailing Address - Fax:
Practice Address - Street 1:6901 N CHARLES ST
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-3780
Practice Address - Country:US
Practice Address - Phone:575-640-1091
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-22
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD02058L235Z00000X
MD09701235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist