MEDICARE: ROBERTA BRESLOW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	00651	MD

General Provider Information

NPI Number	:	1336571223
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERTA BRESLOW

Provider Business Mailing Address
First Line	:	TOWSON UNIVERSITY SPEECH CTR
Second Line	:	8000 YORK ROAD
City	:	TOWSON
State	:	MD
Zip	:	21252-0001
Country	:	US
Telephone Number	:	410-704-3095
Fax Number	:	410-704-6303

Provider Business Practice Location Address
First Line	:	1 OLYMPIC PL STE 200
Second Line	:	TOWSON UNIVERSITY, SPEEC-LANGUAGE-HEARING CENTER
City	:	TOWSON
State	:	MD
Zip	:	21204-4104
Country	:	US
Telephone Number	:	410-704-3095
Fax Number	:	410-704-6303

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/02/2013
Last Update Date	:	08/02/2013

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Directions to “ ROBERTA BRESLOW ” Practice Location

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