Provider Demographics
NPI:1528490836
Name:FLAX, EILEEN FAYE (CCC-SLP)
Entity type:Individual
Prefix:
First Name:EILEEN
Middle Name:FAYE
Last Name:FLAX
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 TROTTERS CT APT 103
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-6733
Mailing Address - Country:US
Mailing Address - Phone:443-562-9879
Mailing Address - Fax:
Practice Address - Street 1:6 TROTTERS CT APT 103
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21208-6733
Practice Address - Country:US
Practice Address - Phone:443-562-9879
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-08
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD07144235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist