Provider Demographics
NPI:1497344113
Name:SYKESVILLE SPEECH THERAPY
Entity Type:Organization
Organization Name:SYKESVILLE SPEECH THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARKE
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:443-452-7524
Mailing Address - Street 1:1814 FALLSTAFF CT
Mailing Address - Street 2:
Mailing Address - City:ELDERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:21784-6274
Mailing Address - Country:US
Mailing Address - Phone:443-452-7524
Mailing Address - Fax:443-281-9025
Practice Address - Street 1:1522 LIBERTY RD STE B
Practice Address - Street 2:
Practice Address - City:SYKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21784-6548
Practice Address - Country:US
Practice Address - Phone:443-516-7752
Practice Address - Fax:443-281-9025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-17
Last Update Date:2021-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty