Provider Demographics
NPI:1538541172
Name:KATIBIAN, NAZGOL (CCC-SLP)
Entity type:Individual
Prefix:
First Name:NAZGOL
Middle Name:
Last Name:KATIBIAN
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3028 FALLSTAFF RD APT E
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-2915
Mailing Address - Country:US
Mailing Address - Phone:310-488-9069
Mailing Address - Fax:
Practice Address - Street 1:3028 FALLSTAFF RD APT E
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21209-2915
Practice Address - Country:US
Practice Address - Phone:310-488-9069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-19
Last Update Date:2015-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD07681235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist