1750404299 NPI number — MS. BETHANY LYN GALLAGHER MS, SLP

Table of content: MS. BETHANY LYN GALLAGHER MS, SLP (NPI 1750404299)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750404299 NPI number — MS. BETHANY LYN GALLAGHER MS, SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GALLAGHER
Provider First Name:
BETHANY
Provider Middle Name:
LYN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MS, SLP
Provider Gender Code:
F

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:
1750404299
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/29/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7103 SHEFFIELD RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21212-1628
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-445-8824
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2225 OLD EMMORTON ROAD
Provider Second Line Business Practice Location Address:
SUITE 210
Provider Business Practice Location Address City Name:
BEL AIR
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21015
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-515-4900
Provider Business Practice Location Address Fax Number:
410-515-0777
Provider Enumeration Date:
04/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  05301 , 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)

  • Identifier: 419800000 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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