Provider Demographics
NPI:1982337887
Name:COLLEGE PARK SPEECH AND LANGUAGE CLINIC, LLC
Entity Type:Organization
Organization Name:COLLEGE PARK SPEECH AND LANGUAGE CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:M IFFT
Authorized Official - Last Name:JORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP
Authorized Official - Phone:301-219-2589
Mailing Address - Street 1:4920 NIAGARA RD STE 220
Mailing Address - Street 2:
Mailing Address - City:COLLEGE PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20740-1174
Mailing Address - Country:US
Mailing Address - Phone:301-345-5436
Mailing Address - Fax:301-345-0624
Practice Address - Street 1:4920 NIAGARA RD STE 220
Practice Address - Street 2:
Practice Address - City:COLLEGE PARK
Practice Address - State:MD
Practice Address - Zip Code:20740-1174
Practice Address - Country:US
Practice Address - Phone:301-345-5436
Practice Address - Fax:301-345-0624
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-07
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty