Provider Demographics
NPI:1679041255
Name:CEVASCO, MONIQUE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:MONIQUE
Middle Name:
Last Name:CEVASCO
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 ARGONNE DR
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-1943
Mailing Address - Country:US
Mailing Address - Phone:410-889-5054
Mailing Address - Fax:
Practice Address - Street 1:801 ARGONNE DR
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-1943
Practice Address - Country:US
Practice Address - Phone:410-889-5054
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-13
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD07800235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD07800OtherMARYLAND STATE LICENSE OF SPEECH-LANGUAGE PATHOLOGY