Provider Demographics
NPI:1063983021
Name:MEAD, DENISE MAXINE (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:MAXINE
Last Name:MEAD
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24780 WOODS DR
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:MD
Mailing Address - Zip Code:21629-2323
Mailing Address - Country:US
Mailing Address - Phone:410-924-7445
Mailing Address - Fax:
Practice Address - Street 1:410 LOCKERMAN ST
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:MD
Practice Address - Zip Code:21629-1048
Practice Address - Country:US
Practice Address - Phone:410-479-2760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05398235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist