Provider Demographics
NPI:1326871641
Name:SICHETTE-VAN SCHAIK, ANGELICA ISABEL (CCC-SLP)
Entity type:Individual
Prefix:
First Name:ANGELICA
Middle Name:ISABEL
Last Name:SICHETTE-VAN SCHAIK
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:ANGELICA
Other - Middle Name:ISABEL
Other - Last Name:BORRERO-SICHETTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4505 MARIGOLD LN
Mailing Address - Street 2:
Mailing Address - City:HURLOCK
Mailing Address - State:MD
Mailing Address - Zip Code:21643-3827
Mailing Address - Country:US
Mailing Address - Phone:443-205-5820
Mailing Address - Fax:
Practice Address - Street 1:301 CHARLES ST
Practice Address - Street 2:
Practice Address - City:HURLOCK
Practice Address - State:MD
Practice Address - Zip Code:21643-3432
Practice Address - Country:US
Practice Address - Phone:410-943-3303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-22
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD11126235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist