Provider Demographics
NPI:1659695120
Name:PHILLIPS, FARAH (SLP)
Entity Type:Individual
Prefix:
First Name:FARAH
Middle Name:
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15005 HEALTH CENTER DR
Mailing Address - Street 2:STE 102
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20716-1017
Mailing Address - Country:US
Mailing Address - Phone:301-805-6070
Mailing Address - Fax:
Practice Address - Street 1:15005 HEALTH CENTER DR
Practice Address - Street 2:STE 102
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20716-1017
Practice Address - Country:US
Practice Address - Phone:301-805-6070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-26
Last Update Date:2016-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05096235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist