Provider Demographics
NPI:1568798742
Name:AZUERO, IRMA
Entity Type:Individual
Prefix:MS
First Name:IRMA
Middle Name:
Last Name:AZUERO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22314 SWEET PEPPERBUSH ALY
Mailing Address - Street 2:
Mailing Address - City:CLARKSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20871-3439
Mailing Address - Country:US
Mailing Address - Phone:240-277-7526
Mailing Address - Fax:
Practice Address - Street 1:9801 GEORGIA AVE STE 229
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20902-5276
Practice Address - Country:US
Practice Address - Phone:301-754-2200
Practice Address - Fax:301-754-2226
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-23
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCNA222Q00000X
MD00117A2355S0801X
DCSLPA0000032355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCSLPA000003OtherSPEECHLANGUAGE PATHOLOGIST ASSISTANT
MD00117AOtherSPEECHLANGUAGE PATHOLOGIST ASSISTANT