Provider Demographics
NPI:1992420160
Name:METKUS, KATE BAILEY (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:KATE
Middle Name:BAILEY
Last Name:METKUS
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 1:207 PURLINGTON RD
Mailing Address - Street 2:
Mailing Address - City:LUTHERVILLE TIMONIUM
Mailing Address - State:MD
Mailing Address - Zip Code:21093-5252
Mailing Address - Country:US
Mailing Address - Phone:215-694-7939
Mailing Address - Fax:
Practice Address - Street 1:1818 POT SPRING RD STE 100
Practice Address - Street 2:
Practice Address - City:TIMONIUM
Practice Address - State:MD
Practice Address - Zip Code:21093-4450
Practice Address - Country:US
Practice Address - Phone:215-694-7939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-10
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD10226235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist