Provider Demographics
NPI:1023426814
Name:MORELLO, AMY BETH (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:BETH
Last Name:MORELLO
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15245 SHADY GROVE RD
Mailing Address - Street 2:STE 110
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-3222
Mailing Address - Country:US
Mailing Address - Phone:301-208-3210
Mailing Address - Fax:301-208-6686
Practice Address - Street 1:15245 SHADY GROVE RD
Practice Address - Street 2:STE 110
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3222
Practice Address - Country:US
Practice Address - Phone:301-208-3210
Practice Address - Fax:301-208-6686
Is Sole Proprietor?:No
Enumeration Date:2014-07-24
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD06722235Z00000X
VA2202007331235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist