Provider Demographics
NPI:1689238768
Name:SPEECH-LANGUAGE SWALLOWING SPECIALIST, LLC
Entity Type:Organization
Organization Name:SPEECH-LANGUAGE SWALLOWING SPECIALIST, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:RACHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:CRAWFORD-BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:301-780-8547
Mailing Address - Street 1:5209 CHESTNUT MANOR CT
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772-3175
Mailing Address - Country:US
Mailing Address - Phone:301-780-8547
Mailing Address - Fax:
Practice Address - Street 1:5209 CHESTNUT MANOR CT
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20772-3175
Practice Address - Country:US
Practice Address - Phone:301-780-8547
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-24
Last Update Date:2019-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty