Healthcare Provider Details

I. General information

NPI: 1871377796
Provider Name (Legal Business Name): DANIELLE LARKIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2023
Last Update Date: 09/10/2024
Certification Date: 09/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10481 CROSS FOX LN
COLUMBIA MD
21044-2199
US

IV. Provider business mailing address

5945 ELK FOREST CT
ELKRIDGE MD
21075-5324
US

V. Phone/Fax

Practice location:
  • Phone: 410-313-6957
  • Fax:
Mailing address:
  • Phone: 443-977-9047
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number11290
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: