Healthcare Provider Details

I. General information

NPI: 1295304111
Provider Name (Legal Business Name): MONICA LACEY NEWPORT M.A., CF-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2021
Last Update Date: 06/24/2021
Certification Date: 06/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1750 E FAIRMOUNT AVE
BALTIMORE MD
21231-1534
US

IV. Provider business mailing address

1201 N CHARLES ST APT 405
BALTIMORE MD
21201-5678
US

V. Phone/Fax

Practice location:
  • Phone: 443-923-9100
  • Fax:
Mailing address:
  • Phone: 614-406-6234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: