Healthcare Provider Details

I. General information

NPI: 1366057408
Provider Name (Legal Business Name): DOMINIQUE BARRETT M.S., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2020
Last Update Date: 08/10/2023
Certification Date: 08/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5801 ALLENTOWN RD STE 410
CAMP SPRINGS MD
20746-4565
US

IV. Provider business mailing address

3300 E WEST HWY APT 341
HYATTSVILLE MD
20782-2180
US

V. Phone/Fax

Practice location:
  • Phone: 301-238-4788
  • Fax:
Mailing address:
  • Phone: 817-896-9587
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number09819
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: