Provider Demographics
NPI:1114525235
Name:GRACEFUL SPEECH-LANGUAGE THERAPY
Entity Type:Organization
Organization Name:GRACEFUL SPEECH-LANGUAGE THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:
Authorized Official - Last Name:HOFFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-720-0585
Mailing Address - Street 1:260 GATEWAY DR STE 20B
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-4239
Mailing Address - Country:US
Mailing Address - Phone:443-720-0585
Mailing Address - Fax:
Practice Address - Street 1:260 GATEWAY DR STE 20B
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-4239
Practice Address - Country:US
Practice Address - Phone:443-720-0585
Practice Address - Fax:443-356-4354
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-12
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty