Provider Demographics
NPI:1629226154
Name:SCULLY, KATHERINE EMILY (MA,CCC-A)
Entity Type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:EMILY
Last Name:SCULLY
Suffix:
Gender:F
Credentials:MA,CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2415 MUSGROVE RD
Mailing Address - Street 2:SUITE 306
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-5200
Mailing Address - Country:US
Mailing Address - Phone:301-384-5977
Mailing Address - Fax:301-384-5976
Practice Address - Street 1:2415 MUSGROVE RD
Practice Address - Street 2:SUITE 306
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-5200
Practice Address - Country:US
Practice Address - Phone:301-384-5977
Practice Address - Fax:301-384-5976
Is Sole Proprietor?:No
Enumeration Date:2008-09-09
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01108231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist