Basic Information
| Provider Information | |||||||||
| NPI: | 1558576710 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GLICK | ||||||||
| FirstName: | KATHERINE | ||||||||
| MiddleName: | GALLO | ||||||||
| NamePrefix: | MISS | ||||||||
| NameSuffix: | |||||||||
| Credential: | MA, CCC-SLP/L | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | GALLO | ||||||||
| OtherFirstName: | KATHERINE | ||||||||
| OtherMiddleName: | MARIE | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 7540 SAWMILL PARKWAY | ||||||||
| Address2: | SUITE A-2 | ||||||||
| City: | POWELL | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430659845 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6145707252 | ||||||||
| FaxNumber: | 6148409310 | ||||||||
| Practice Location | |||||||||
| Address1: | 7540 SAWMILL PARKWAY | ||||||||
| Address2: | SUITE A-2 | ||||||||
| City: | POWELL | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430659845 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6145707252 | ||||||||
| FaxNumber: | 6148409310 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/11/2007 | ||||||||
| LastUpdateDate: | 11/14/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | SP 8666 | OH | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 235Z00000X | ASHA 12126404 | OH | N | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.