Basic Information
| Provider Information | |||||||||
| NPI: | 1093072530 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCCORMICK | ||||||||
| FirstName: | HEATHER | ||||||||
| MiddleName: | DANIELLE | ||||||||
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| Credential: | M.S., CCC-SLP, CLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3230 GREENWAY DR | ||||||||
| Address2: | |||||||||
| City: | ELLICOTT CITY | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210422418 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4439231842 | ||||||||
| FaxNumber: | 4439231875 | ||||||||
| Practice Location | |||||||||
| Address1: | 707 N BROADWAY | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212051832 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4439239200 | ||||||||
| FaxNumber: | 4439231875 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/23/2012 | ||||||||
| LastUpdateDate: | 10/24/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/24/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 06851 | MD | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.