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General NPI Number Information
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NPI Number | 1912156902
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Entity Type | Individual
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Provider Name | BEVERLY JO GALLAGHER PHD,CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 09/15/2008
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Last Update Date | 09/15/2008
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Provider Practice Location Address
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Address Line | 20294 GARRETT HWY STE 1
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City | OAKLAND
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State | MD
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Zip | 21550-7398
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Country | US
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Telephone | 310-387-5580
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Fax | 443-927-9126
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Provider Business Mailing Address
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Address Line | 20294 GARRETT HWY STE 1
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City | OAKLAND
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State | MD
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Zip | 21550-7398
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Country | US
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Telephone | 310-387-5580
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Fax | 443-927-9126
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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 | 000777
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License Number State | MD
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