Provider Demographics
NPI:1063979664
Name:ADULT SPEECH THERAPY SERVICES LLC
Entity type:Organization
Organization Name:ADULT SPEECH THERAPY SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:G
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP
Authorized Official - Phone:301-323-8486
Mailing Address - Street 1:17725 TREE LAWN DR
Mailing Address - Street 2:
Mailing Address - City:ASHTON
Mailing Address - State:MD
Mailing Address - Zip Code:20861-3342
Mailing Address - Country:US
Mailing Address - Phone:301-323-8486
Mailing Address - Fax:240-422-8283
Practice Address - Street 1:17830 NEW HAMPSHIRE AVE STE 300
Practice Address - Street 2:
Practice Address - City:ASHTON
Practice Address - State:MD
Practice Address - Zip Code:20861-3644
Practice Address - Country:US
Practice Address - Phone:301-323-8486
Practice Address - Fax:240-422-8283
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-01
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD212044500Medicaid