Provider Demographics
NPI:1922298538
Name:MARSICO, KATELYN MARY (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KATELYN
Middle Name:MARY
Last Name:MARSICO
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3708 BOLD RULER CT
Mailing Address - Street 2:
Mailing Address - City:GLENELG
Mailing Address - State:MD
Mailing Address - Zip Code:21737-9728
Mailing Address - Country:US
Mailing Address - Phone:104-635-4214
Mailing Address - Fax:
Practice Address - Street 1:13400 TRIADELPHIA RD
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-1133
Practice Address - Country:US
Practice Address - Phone:410-313-2560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-30
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05502235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist