Healthcare Provider Details

I. General information

NPI: 1528724580
Provider Name (Legal Business Name): COLBY JACOB LEMKE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2021
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date: 06/24/2026
Reactivation Date: 08/17/2026

III. Provider practice location address

1220 E JOPPA RD STE 332
TOWSON MD
21286-5811
US

IV. Provider business mailing address

1220 E JOPPA RD STE 332
TOWSON MD
21286-5811
US

V. Phone/Fax

Practice location:
  • Phone: 443-353-9547
  • Fax:
Mailing address:
  • Phone: 443-353-9547
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number11980
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: