Provider Demographics
NPI:1912156902
Name:GALLAGHER, BEVERLY JO (PHD,CCC-SLP)
Entity Type:Individual
Prefix:DR
First Name:BEVERLY
Middle Name:JO
Last Name:GALLAGHER
Suffix:
Gender:F
Credentials:PHD,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20294 GARRETT HWY STE 1
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21550-7398
Mailing Address - Country:US
Mailing Address - Phone:310-387-5580
Mailing Address - Fax:443-927-9126
Practice Address - Street 1:20294 GARRETT HWY STE 1
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:MD
Practice Address - Zip Code:21550-7398
Practice Address - Country:US
Practice Address - Phone:310-387-5580
Practice Address - Fax:443-927-9126
Is Sole Proprietor?:No
Enumeration Date:2008-09-15
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD000777235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist