Provider Demographics
NPI:1700354370
Name:CETUK, MONICA NAKAMURA (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:NAKAMURA
Last Name:CETUK
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:MONICA
Other - Middle Name:
Other - Last Name:NAKAMURA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:9 GREENDALE PL
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-1603
Mailing Address - Country:US
Mailing Address - Phone:301-379-3065
Mailing Address - Fax:
Practice Address - Street 1:5006 RIVERDALE RD
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:MD
Practice Address - Zip Code:20737-1916
Practice Address - Country:US
Practice Address - Phone:301-985-1850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-13
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03585235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist