Provider Demographics
NPI:1124580428
Name:HURLEY, JOELLEN MICHELLE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JOELLEN
Middle Name:MICHELLE
Last Name:HURLEY
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 1:2704 PROCTOR LN
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21234-1904
Mailing Address - Country:US
Mailing Address - Phone:410-404-6809
Mailing Address - Fax:
Practice Address - Street 1:2704 PROCTOR LN
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21234-1904
Practice Address - Country:US
Practice Address - Phone:410-404-6809
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-04
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD02669235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist