=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154449304
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALDERMAN SPEECH PATHOLOGY SERVICES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/27/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 825 WASHINGTON BLVD
-----------------------------------------------------
City | BALTIMORE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21230-2324
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 240-821-5765
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11544 LOCKWOOD DR APT A1
-----------------------------------------------------
City | SILVER SPRING
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20904-2426
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 240-353-3455
-----------------------------------------------------
Fax | 301-680-5355
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. MICHAEL ANTHONY DRAUGHON
-----------------------------------------------------
Credential | M.A. CCC-SLP
-----------------------------------------------------
Telephone | 240-353-3455
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QH0700X
-----------------------------------------------------
Taxonomy Name | Hearing and Speech Clinic/Center
-----------------------------------------------------
License Number | 04022
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------