=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841656519
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOANNE MCLANE HARDESTY SLP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/11/2016
-----------------------------------------------------
Last Update Date | 01/11/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2500 WALLINGTON WAY SUITE 103
-----------------------------------------------------
City | MARRIOTTSVILLE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21104-1505
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-442-9791
-----------------------------------------------------
Fax | 410-442-9783
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5214 KERGER RD
-----------------------------------------------------
City | ELLICOTT CITY
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21043-7012
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-744-1965
-----------------------------------------------------
Fax | 410-442-9783
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | 04973
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------