Provider Demographics
NPI:1255575593
Name:CANEPA, PATRICIA (MA CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:
Last Name:CANEPA
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 GLENVILLE RD
Mailing Address - Street 2:
Mailing Address - City:CHURCHVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21028-1414
Mailing Address - Country:US
Mailing Address - Phone:443-807-6567
Mailing Address - Fax:410-734-6699
Practice Address - Street 1:217 GLENVILLE RD
Practice Address - Street 2:
Practice Address - City:CHURCHVILLE
Practice Address - State:MD
Practice Address - Zip Code:21028-1414
Practice Address - Country:US
Practice Address - Phone:443-807-6567
Practice Address - Fax:410-734-6699
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-30
Last Update Date:2009-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03230235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist