Provider Demographics
NPI:1699026997
Name:COMMUNICATION BUILDERS THERAPEUTIC SERVICES, LLC
Entity Type:Organization
Organization Name:COMMUNICATION BUILDERS THERAPEUTIC SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:OLISA
Authorized Official - Middle Name:
Authorized Official - Last Name:SANDIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:301-485-9302
Mailing Address - Street 1:3507 DIXON ST
Mailing Address - Street 2:
Mailing Address - City:TEMPLE HILLS
Mailing Address - State:MD
Mailing Address - Zip Code:20748-4214
Mailing Address - Country:US
Mailing Address - Phone:301-485-9302
Mailing Address - Fax:
Practice Address - Street 1:3507 DIXON ST
Practice Address - Street 2:
Practice Address - City:TEMPLE HILLS
Practice Address - State:MD
Practice Address - Zip Code:20748-4214
Practice Address - Country:US
Practice Address - Phone:301-485-9302
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-26
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD06555235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD33590101Medicaid