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General NPI Number Information
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NPI Number | 1043150634
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Entity Type | Organization
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Legal Business Name | MOMMAS LIGHT THERAPY CO
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Dates
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Enumeration Date | 03/31/2026
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Last Update Date | 03/31/2026
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Provider Practice Location Address
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Address Line | 2425 SOLOMONS ISLAND RD
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City | HUNTINGTOWN
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State | MD
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Zip | 20639-8704
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Country | US
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Telephone | 410-343-9366
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Fax |
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Provider Business Mailing Address
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Address Line | 3501 FORTUNA CT
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City | HUNTINGTOWN
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State | MD
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Zip | 20639-4202
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Country | US
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Telephone | 717-433-3617
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Fax |
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Authorized Official
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Title or Position | CEO/OWNER
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Name | JENNIFER MARY ANN ANDERSON
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Credential | M.S., CCC-SLP
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Telephone | 717-433-3617
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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