Individual
KASEY KATHLEEN MACMILLAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CCC-SLP
Contact information
Practice address
6040 HARFORD RD, BALTIMORE, MD 21214-1327
(901) 573-1381
(410) 254-0619
Mailing address
2809 BOSTON ST, #423, BALTIMORE, MD 21224-4814
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
04542
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
04542
STATE LICENSE
MD
Enumeration date
04/11/2007
Last updated
07/08/2007
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