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General NPI Number Information
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NPI Number | 1730505363
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Entity Type | Organization
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Legal Business Name | KENNEDY KRIEGER INSTITUTE
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Dates
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Enumeration Date | 03/06/2014
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Last Update Date | 03/06/2014
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Provider Practice Location Address
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Address Line | 1525 LIGHT ST
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City | BALTIMORE
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State | MD
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Zip | 21230-4516
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Country | US
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Telephone | 610-505-1291
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Fax |
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Provider Business Mailing Address
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Address Line | 1525 LIGHT ST
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City | BALTIMORE
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State | MD
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Zip | 21230-4516
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Country | US
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Telephone | 610-505-1291
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Fax |
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Authorized Official
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Title or Position | SPEECH-LANGUAGE PATHOLOGIST
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Name | CAROLYN REICH
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Credential | M.A. CCC-SLP
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Telephone | 610-505-1291
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0700X
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Taxonomy Name | Hearing and Speech Clinic/Center
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License Number | 07292
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License Number State | MD
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