Healthcare Provider Details

I. General information

NPI: 1568374601
Provider Name (Legal Business Name): SUGARLOAF SPEECH THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5440 ADAMSTOWN COMMONS DR
ADAMSTOWN MD
21710-8922
US

IV. Provider business mailing address

5440 ADAMSTOWN COMMONS DR
ADAMSTOWN MD
21710-8922
US

V. Phone/Fax

Practice location:
  • Phone: 443-519-9810
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LEA ANGELICA BOLLOZOS TANSECO
Title or Position: SPEECH LANGUAGE PATHOLOGIST
Credential:
Phone: 443-519-9810