Provider Demographics
NPI:1740606979
Name:DOWNS, BERNETTE JOHNELLE (SLP)
Entity Type:Individual
Prefix:
First Name:BERNETTE
Middle Name:JOHNELLE
Last Name:DOWNS
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 1:2727 FRIDAY HARBOR DR
Mailing Address - Street 2:
Mailing Address - City:SYKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21784-6941
Mailing Address - Country:US
Mailing Address - Phone:202-230-3939
Mailing Address - Fax:202-330-5001
Practice Address - Street 1:2727 FRIDAY HARBOR DR
Practice Address - Street 2:
Practice Address - City:SYKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21784-6941
Practice Address - Country:US
Practice Address - Phone:202-230-3939
Practice Address - Fax:202-330-5001
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-12
Last Update Date:2014-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05977235Z00000X
DCSLP000399235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD338705400Medicaid
MD338705401Medicaid