1841663168 NPI number — CARE SPEECH LANGUAGE PATHOLOGY SERVICE, LLC

Table of content: (NPI 1841663168)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841663168 NPI number — CARE SPEECH LANGUAGE PATHOLOGY SERVICE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARE SPEECH LANGUAGE PATHOLOGY SERVICE, LLC
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:
1841663168
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/09/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9308 MIDLAND TURN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
UPPER MARLBORO
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20772-5367
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
202-386-8745
Provider Business Mailing Address Fax Number:
301-423-5010

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9308 MIDLAND TURN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
UPPER MARLBORO
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20772-5367
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-386-8745
Provider Business Practice Location Address Fax Number:
301-423-5010
Provider Enumeration Date:
11/09/2015

Additional Information

Authorized Official

Authorized Official Last Name:
COOPER
Authorized Official First Name:
MARIE
Authorized Official Middle Name:
DIANE
Authorized Official Title or Position:
SPEECH AND LANGUAGE PATHOLOGIST
Authorized Official Telephone Number:
202-386-8745

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  SLP000531 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: SLP000531 . This is a "DISTRICT OF COLUMBIA MEDICARE" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".




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