Provider Demographics
NPI:1770204810
Name:LICATATISO, MARIA G (CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:MARIA
Middle Name:G
Last Name:LICATATISO
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 1:3780 SADIE LN
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:OH
Mailing Address - Zip Code:44212-4430
Mailing Address - Country:US
Mailing Address - Phone:440-666-2189
Mailing Address - Fax:
Practice Address - Street 1:3780 SADIE LN
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:OH
Practice Address - Zip Code:44212-4430
Practice Address - Country:US
Practice Address - Phone:440-666-2189
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-07
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist