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General NPI Number Information
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NPI Number | 1871850115
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Entity Type | Individual
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Provider Name | JACALYN BAXENDALE MA, CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 04/11/2012
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Last Update Date | 12/01/2020
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Provider Practice Location Address
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Address Line | 29000 INFORMATION LN STE 507
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City | EASTON
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State | MD
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Zip | 21601-7032
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Country | US
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Telephone | 410-822-2213
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Fax |
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Provider Business Mailing Address
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Address Line | 106 BOUNDARY LN
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City | ST MICHAELS
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State | MD
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Zip | 21663-2616
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Country | US
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Telephone | 856-701-3117
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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 | SL010169
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 41YS00658900
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License Number State | NJ
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Taxonomy #3
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 08237
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License Number State | MD
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