Provider Demographics
NPI:1619686136
Name:FARNUM BADLEY, JOLIE (MSC, CCC)
Entity Type:Individual
Prefix:
First Name:JOLIE
Middle Name:
Last Name:FARNUM BADLEY
Suffix:
Gender:F
Credentials:MSC, CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 LONG TRAIL LN
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-7772
Mailing Address - Country:US
Mailing Address - Phone:202-993-1170
Mailing Address - Fax:
Practice Address - Street 1:800 S FREDERICK AVE STE 101
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-4151
Practice Address - Country:US
Practice Address - Phone:240-200-5305
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-23
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD10277235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist