Provider Demographics
NPI:1740897438
Name:SALVESEN, LILLA ISABELLE (MS SLP CFY)
Entity type:Individual
Prefix:
First Name:LILLA
Middle Name:ISABELLE
Last Name:SALVESEN
Suffix:
Gender:F
Credentials:MS SLP CFY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 OAK BLUFF RD
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER
Mailing Address - State:MD
Mailing Address - Zip Code:21037-2133
Mailing Address - Country:US
Mailing Address - Phone:443-758-8900
Mailing Address - Fax:
Practice Address - Street 1:8644 WATER FALL DR
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20723-2033
Practice Address - Country:US
Practice Address - Phone:410-656-2622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-26
Last Update Date:2020-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD02213L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist