Provider Demographics
NPI:1699055798
Name:MCGILLICK, MAUREEN C (MS, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:MAUREEN
Middle Name:C
Last Name:MCGILLICK
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 1:200 E JOPPA RD STE LL101
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-3105
Mailing Address - Country:US
Mailing Address - Phone:410-296-6086
Mailing Address - Fax:410-296-6086
Practice Address - Street 1:200 E JOPPA RD STE LL 101
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-3105
Practice Address - Country:US
Practice Address - Phone:410-296-6086
Practice Address - Fax:410-296-6086
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-19
Last Update Date:2011-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01289235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist