Provider Demographics
NPI:1609911775
Name:MELLOTT, KATHLEEN E (AUD)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:E
Last Name:MELLOTT
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15209 MARLBORO PIKE STE 208
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772-3151
Mailing Address - Country:US
Mailing Address - Phone:301-780-6770
Mailing Address - Fax:301-780-6772
Practice Address - Street 1:15209 MARLBORO PIKE STE 208
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20772-3151
Practice Address - Country:US
Practice Address - Phone:301-780-6770
Practice Address - Fax:301-780-6772
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD171231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDG01615C01Medicare ID - Type UnspecifiedMEDICARE PROVIDER
MDG01654A01Medicare ID - Type Unspecified