Provider Demographics
NPI:1750620969
Name:MUTH, TRISHA A BENTS (AU D)
Entity type:Individual
Prefix:
First Name:TRISHA
Middle Name:A BENTS
Last Name:MUTH
Suffix:
Gender:F
Credentials:AU D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:424 BARNES ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-3958
Mailing Address - Country:US
Mailing Address - Phone:410-838-4327
Mailing Address - Fax:410-510-1814
Practice Address - Street 1:424 BARNES ST
Practice Address - Street 2:SUITE 102
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-3958
Practice Address - Country:US
Practice Address - Phone:410-838-4327
Practice Address - Fax:410-510-1814
Is Sole Proprietor?:No
Enumeration Date:2013-02-07
Last Update Date:2015-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01254231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD335906900Medicaid
MD270826ZPQ3Medicare PIN