Provider Demographics
NPI:1013219781
Name:SPECIAL EDUCATION RESOURCES, LLC
Entity Type:Organization
Organization Name:SPECIAL EDUCATION RESOURCES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:J
Authorized Official - Last Name:TRAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:301-367-1651
Mailing Address - Street 1:6915 LAUREL BOWIE RD
Mailing Address - Street 2:SUITE 205-F
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20715-1703
Mailing Address - Country:US
Mailing Address - Phone:240-245-4370
Mailing Address - Fax:240-245-4472
Practice Address - Street 1:6915 LAUREL BOWIE RD
Practice Address - Street 2:SUITE 205-F
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20715-1703
Practice Address - Country:US
Practice Address - Phone:240-245-4370
Practice Address - Fax:240-245-4472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-01
Last Update Date:2011-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01507235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty