Provider Demographics
NPI:1821127481
Name:BANICK, PATRICIA LYNN (MA, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:LYNN
Last Name:BANICK
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 E GORDON ST
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-2917
Mailing Address - Country:US
Mailing Address - Phone:410-638-7294
Mailing Address - Fax:
Practice Address - Street 1:2225 OLD EMMORTON ROAD
Practice Address - Street 2:SUITE 210
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21015
Practice Address - Country:US
Practice Address - Phone:410-515-4900
Practice Address - Fax:410-515-0777
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01975235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD88908901OtherCAREFIRST BCBS