Provider Demographics
NPI:1073218855
Name:MITCHUM, KARLIE MARIE (MS/CCC-SLP)
Entity type:Individual
Prefix:
First Name:KARLIE
Middle Name:MARIE
Last Name:MITCHUM
Suffix:
Gender:
Credentials:MS/CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:902 DAWES CT
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-2615
Mailing Address - Country:US
Mailing Address - Phone:443-966-0258
Mailing Address - Fax:
Practice Address - Street 1:650 MCHENRY RD
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:MD
Practice Address - Zip Code:21001-2607
Practice Address - Country:US
Practice Address - Phone:443-843-6320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-03
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD09948235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist