1528437621 NPI number — CREATIVE SPEECH & LANGUAGE THERAPY

Table of content: (NPI 1528437621)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528437621 NPI number — CREATIVE SPEECH & LANGUAGE THERAPY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CREATIVE SPEECH & LANGUAGE THERAPY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1528437621
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/18/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2104 PINEY BRANCH CIR
Provider Second Line Business Mailing Address:
#303
Provider Business Mailing Address City Name:
HANOVER
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21076-1833
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-841-4514
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2104 PINEY BRANCH CIR
Provider Second Line Business Practice Location Address:
#303
Provider Business Practice Location Address City Name:
HANOVER
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21076-1833
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-841-4514
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/18/2015

Additional Information

Authorized Official

Authorized Official Last Name:
DAVIS
Authorized Official First Name:
JOCELYN
Authorized Official Middle Name:
C
Authorized Official Title or Position:
SPEECH-LANGUAGE PATHOLOGIST
Authorized Official Telephone Number:
410-841-4514

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  07593 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com