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General NPI Number Information
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NPI Number | 1780156216
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Entity Type | Individual
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Provider Name | MARILYN E GENTLES
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Gender | Female
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Dates
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Enumeration Date | 12/21/2018
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Last Update Date | 12/21/2018
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Provider Practice Location Address
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Address Line | 1400 NALLEY TER RM 20
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City | LANDOVER
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State | MD
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Zip | 20785-4434
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Country | US
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Telephone | 301-772-7992
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Fax |
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Provider Business Mailing Address
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Address Line | 6402 OLD LANDOVER RD
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City | CHEVERLY
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State | MD
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Zip | 20785-1026
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Country | US
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Telephone | 301-772-7992
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 07549
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License Number State | MD
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