Basic Information
| Provider Information | |||||||||
| NPI: | 1609911775 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MELLOTT | ||||||||
| FirstName: | KATHLEEN | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | AU.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15209 MARLBORO PIKE STE 208 | ||||||||
| Address2: | |||||||||
| City: | UPPER MARLBORO | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207723151 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3017806770 | ||||||||
| FaxNumber: | 3017806772 | ||||||||
| Practice Location | |||||||||
| Address1: | 15209 MARLBORO PIKE STE 208 | ||||||||
| Address2: | |||||||||
| City: | UPPER MARLBORO | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207723151 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3017806770 | ||||||||
| FaxNumber: | 3017806772 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/20/2007 | ||||||||
| LastUpdateDate: | 07/16/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | 171 | MD | Y | Speech, Language and Hearing Service Providers | Audiologist |
No ID Information.