Provider Demographics
NPI:1801442850
Name:PECORARO, HEATHER STRAKA
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:STRAKA
Last Name:PECORARO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7513 IROQUOIS AVE
Mailing Address - Street 2:
Mailing Address - City:SPARROWS POINT
Mailing Address - State:MD
Mailing Address - Zip Code:21219-2123
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1500 IMLA ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224-6142
Practice Address - Country:US
Practice Address - Phone:410-396-9086
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-15
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD07275235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD07275OtherMD LICENSE