Provider Demographics
NPI:1689938276
Name:LAW, JOHNELLE MONIQUE (M ED)
Entity Type:Individual
Prefix:
First Name:JOHNELLE
Middle Name:MONIQUE
Last Name:LAW
Suffix:
Gender:F
Credentials:M ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15300 BENNETTS RUN CT
Mailing Address - Street 2:
Mailing Address - City:BRANDYWINE
Mailing Address - State:MD
Mailing Address - Zip Code:20613-6287
Mailing Address - Country:US
Mailing Address - Phone:240-530-0564
Mailing Address - Fax:
Practice Address - Street 1:15300 BENNETTS RUN CT
Practice Address - Street 2:
Practice Address - City:BRANDYWINE
Practice Address - State:MD
Practice Address - Zip Code:20613-6287
Practice Address - Country:US
Practice Address - Phone:240-530-0564
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-27
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD07936235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist