Provider Demographics
NPI:1841656519
Name:HARDESTY, JOANNE MCLANE (SLP)
Entity type:Individual
Prefix:
First Name:JOANNE
Middle Name:MCLANE
Last Name:HARDESTY
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 1:5214 KERGER RD
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-7012
Mailing Address - Country:US
Mailing Address - Phone:410-744-1965
Mailing Address - Fax:410-442-9783
Practice Address - Street 1:2500 WALLINGTON WAY
Practice Address - Street 2:SUITE 103
Practice Address - City:MARRIOTTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21104-1505
Practice Address - Country:US
Practice Address - Phone:410-442-9791
Practice Address - Fax:410-442-9783
Is Sole Proprietor?:No
Enumeration Date:2016-01-11
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04973235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist