Provider Demographics
NPI:1679605133
Name:CLOONAN, CHRISTINE B (MA CCCA)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:B
Last Name:CLOONAN
Suffix:
Gender:F
Credentials:MA CCCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:520 UPPER CHESAPEAKE DRIVE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014
Mailing Address - Country:US
Mailing Address - Phone:410-879-9100
Mailing Address - Fax:410-879-0227
Practice Address - Street 1:520 UPPER CHESAPEAKE DRIVE
Practice Address - Street 2:SUITE 206
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014
Practice Address - Country:US
Practice Address - Phone:410-879-9100
Practice Address - Fax:410-879-0227
Is Sole Proprietor?:No
Enumeration Date:2007-03-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD00851231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist