Provider Demographics
NPI:1376766022
Name:ASSOCIATED SPEECH & LANGUAGE SERVICES INC.
Entity Type:Organization
Organization Name:ASSOCIATED SPEECH & LANGUAGE SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:REGINA
Authorized Official - Last Name:OURAND
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:443-759-3153
Mailing Address - Street 1:400 E PRATT ST
Mailing Address - Street 2:SUITE 830
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21202-3116
Mailing Address - Country:US
Mailing Address - Phone:443-759-3153
Mailing Address - Fax:443-759-3001
Practice Address - Street 1:400 E PRATT ST
Practice Address - Street 2:SUITE 830
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-3116
Practice Address - Country:US
Practice Address - Phone:443-759-3153
Practice Address - Fax:443-759-3001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01134235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD21-6534Medicare ID - Type UnspecifiedMEDICARE PROVIDER