Provider Demographics
NPI:1447728035
Name:MCTAVISH, ERIN MARIE (MS,CCC-SLP #4183)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:MARIE
Last Name:MCTAVISH
Suffix:
Gender:F
Credentials:MS,CCC-SLP #4183
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3623 SPRINGHOLLOW LN
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21704-7370
Mailing Address - Country:US
Mailing Address - Phone:301-728-9221
Mailing Address - Fax:
Practice Address - Street 1:11690 NEELSVILLE CHURCH RD
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20876-4127
Practice Address - Country:US
Practice Address - Phone:301-353-0972
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-13
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MH04183235Z00000X
MD04183235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist