Provider Demographics
NPI:1922603380
Name:BALTIMORE SPEECH THERAPY, LLC
Entity Type:Organization
Organization Name:BALTIMORE SPEECH THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:B
Authorized Official - Last Name:SHOFF
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-SLP
Authorized Official - Phone:443-834-2660
Mailing Address - Street 1:1 SPARKS STATION RD
Mailing Address - Street 2:
Mailing Address - City:SPARKS GLENCOE
Mailing Address - State:MD
Mailing Address - Zip Code:21152-9334
Mailing Address - Country:US
Mailing Address - Phone:443-834-2660
Mailing Address - Fax:
Practice Address - Street 1:1 SPARKS STATION RD
Practice Address - Street 2:
Practice Address - City:SPARKS GLENCOE
Practice Address - State:MD
Practice Address - Zip Code:21152-9334
Practice Address - Country:US
Practice Address - Phone:443-834-2660
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-03
Last Update Date:2024-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1538358171Medicaid