Provider Demographics
NPI:1508385790
Name:MENESES, RAELENE (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:RAELENE
Middle Name:
Last Name:MENESES
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 1:6802 MCCLEAN BLVD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21234-7200
Mailing Address - Country:US
Mailing Address - Phone:410-269-7600
Mailing Address - Fax:
Practice Address - Street 1:410 E JEFFREY ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21225-2040
Practice Address - Country:US
Practice Address - Phone:410-296-7600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-19
Last Update Date:2020-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04376235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist