Provider Demographics
NPI:1396573747
Name:LISTEN, SPEAK AND COMMUNICATE SPEECH LANGUAGE PATHOLOGY
Entity type:Organization
Organization Name:LISTEN, SPEAK AND COMMUNICATE SPEECH LANGUAGE PATHOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:E
Authorized Official - Last Name:GWYNNE-ORS
Authorized Official - Suffix:
Authorized Official - Credentials:MS SLP
Authorized Official - Phone:443-545-6341
Mailing Address - Street 1:1587 BRIMFIELD CIR
Mailing Address - Street 2:
Mailing Address - City:SYKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21784-5938
Mailing Address - Country:US
Mailing Address - Phone:443-545-6341
Mailing Address - Fax:
Practice Address - Street 1:1587 BRIMFIELD CIR
Practice Address - Street 2:
Practice Address - City:SYKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21784-5938
Practice Address - Country:US
Practice Address - Phone:443-545-6341
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-25
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty