Provider Demographics
NPI:1548730666
Name:CILLO, TAMI R (SPEECH PATHOLOGIST)
Entity type:Individual
Prefix:
First Name:TAMI
Middle Name:R
Last Name:CILLO
Suffix:
Gender:F
Credentials:SPEECH PATHOLOGIST
Other - Prefix:
Other - First Name:TAMI
Other - Middle Name:M
Other - Last Name:RIDGLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SPEECH PATHOLOGIST
Mailing Address - Street 1:1217 DULWICH LN
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-2576
Mailing Address - Country:US
Mailing Address - Phone:443-807-7302
Mailing Address - Fax:
Practice Address - Street 1:100 THOMAS RUN RD
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21015-1616
Practice Address - Country:US
Practice Address - Phone:106-383-8234
Practice Address - Fax:410-638-3825
Is Sole Proprietor?:No
Enumeration Date:2018-12-01
Last Update Date:2018-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01546235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist