Provider Demographics
NPI:1164717724
Name:COULSON, BIANCA (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:BIANCA
Middle Name:
Last Name:COULSON
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:BIANCA
Other - Middle Name:
Other - Last Name:GRESCO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:7310 RITCHIE HWY
Mailing Address - Street 2:STE 500
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-3065
Mailing Address - Country:US
Mailing Address - Phone:410-766-4047
Mailing Address - Fax:
Practice Address - Street 1:7310 RITCHIE HWY
Practice Address - Street 2:STE 500
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-3065
Practice Address - Country:US
Practice Address - Phone:410-766-4047
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-12
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD0214A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist