Provider Demographics
NPI:1225142086
Name:TOWSON UNIVERSITY SPEECH-LANGUAGE-HEARING CLINIC
Entity Type:Organization
Organization Name:TOWSON UNIVERSITY SPEECH-LANGUAGE-HEARING CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH CLINIC DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:POTTASH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-704-3095
Mailing Address - Street 1:TOWSON UNIVERSITY SPEECH-HEARING-CLINIC
Mailing Address - Street 2:8000 YORK ROAD
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21252-0001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:410-704-6303
Practice Address - Street 1:TOWSON UNIVERSITY SPEECH-HEARING-CLINIC
Practice Address - Street 2:8000 YORK ROAD
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21252-0001
Practice Address - Country:US
Practice Address - Phone:410-704-3095
Practice Address - Fax:410-704-6303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01329235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD234438600Medicaid
MDN199OtherFEDERAL BLUE CROSS