Provider Demographics
NPI:1427377548
Name:SOUTHERN MARYLAND SPEECH AND LANGUAGE SERVICES
Entity Type:Organization
Organization Name:SOUTHERN MARYLAND SPEECH AND LANGUAGE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TANYA
Authorized Official - Middle Name:
Authorized Official - Last Name:SPINNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-684-3032
Mailing Address - Street 1:PO BOX 271
Mailing Address - Street 2:
Mailing Address - City:POMFRET
Mailing Address - State:MD
Mailing Address - Zip Code:20675-0271
Mailing Address - Country:US
Mailing Address - Phone:301-684-3032
Mailing Address - Fax:301-645-5695
Practice Address - Street 1:3270 ELSA AVE
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20603-4048
Practice Address - Country:US
Practice Address - Phone:301-684-3032
Practice Address - Fax:301-645-5695
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-28
Last Update Date:2010-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty