Provider Demographics
NPI:1558576710
Name:GLICK, KATHERINE GALLO (MA, CCC-SLP/L)
Entity Type:Individual
Prefix:MISS
First Name:KATHERINE
Middle Name:GALLO
Last Name:GLICK
Suffix:
Gender:F
Credentials:MA, CCC-SLP/L
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:MARIE
Other - Last Name:GALLO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:7540 SAWMILL PARKWAY
Mailing Address - Street 2:SUITE A-2
Mailing Address - City:POWELL
Mailing Address - State:OH
Mailing Address - Zip Code:43065-9845
Mailing Address - Country:US
Mailing Address - Phone:614-570-7252
Mailing Address - Fax:614-840-9310
Practice Address - Street 1:7540 SAWMILL PARKWAY
Practice Address - Street 2:SUITE A-2
Practice Address - City:POWELL
Practice Address - State:OH
Practice Address - Zip Code:43065-9845
Practice Address - Country:US
Practice Address - Phone:614-570-7252
Practice Address - Fax:614-840-9310
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP 8666235Z00000X
OHASHA 12126404235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist