Provider Demographics
NPI:1124591755
Name:ANTOLICK, SHARRON (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:SHARRON
Middle Name:
Last Name:ANTOLICK
Suffix:
Gender:F
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 1:7163 NORRIS AVE
Mailing Address - Street 2:
Mailing Address - City:SYKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21784-6665
Mailing Address - Country:US
Mailing Address - Phone:301-675-1736
Mailing Address - Fax:
Practice Address - Street 1:125 N COURT ST
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-5192
Practice Address - Country:US
Practice Address - Phone:410-876-3000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-07
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01770235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist