Provider Demographics
NPI:1568813889
Name:DREW, MAGGIE
Entity Type:Individual
Prefix:
First Name:MAGGIE
Middle Name:
Last Name:DREW
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 1:57 JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:LONACONING
Mailing Address - State:MD
Mailing Address - Zip Code:21539-1307
Mailing Address - Country:US
Mailing Address - Phone:301-463-5451
Mailing Address - Fax:
Practice Address - Street 1:57 JACKSON ST
Practice Address - Street 2:
Practice Address - City:LONACONING
Practice Address - State:MD
Practice Address - Zip Code:21539-1307
Practice Address - Country:US
Practice Address - Phone:301-463-5451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-28
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MD08491235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program