MEDICARE: DENISE MAXINE MEAD MS, CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	05398	MD

General Provider Information

NPI Number	:	1063983021
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DENISE MAXINE MEAD MS, CCC-SLP

Provider Business Mailing Address
First Line	:	24780 WOODS DR
Second Line	:
City	:	DENTON
State	:	MD
Zip	:	21629-2323
Country	:	US
Telephone Number	:	410-924-7445
Fax Number	:

Provider Business Practice Location Address
First Line	:	410 LOCKERMAN ST
Second Line	:
City	:	DENTON
State	:	MD
Zip	:	21629-1048
Country	:	US
Telephone Number	:	410-479-2760
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/16/2018
Last Update Date	:	12/16/2018

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