MEDICARE: DANIELLE MARIE BAGLEY M.S., CCC-SLP

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	08777	MD

General Provider Information

NPI Number	:	1497376867
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIELLE MARIE BAGLEY M.S., CCC-SLP

Provider Business Mailing Address
First Line	:	10344 HICKORY RIDGE RD APT 428
Second Line	:
City	:	COLUMBIA
State	:	MD
Zip	:	21044-4859
Country	:	US
Telephone Number	:	410-842-7020
Fax Number	:

Provider Business Practice Location Address
First Line	:	1051 BRIGHTSEAT RD
Second Line	:
City	:	LANDOVER
State	:	MD
Zip	:	20785-3738
Country	:	US
Telephone Number	:	240-487-4400
Fax Number	:

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

Provider Enumeration Date	:	04/27/2020
Last Update Date	:	04/27/2020

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Directions to “ DANIELLE MARIE BAGLEY M.S., CCC-SLP” Practice Location

Language	Start Address	Practice Location

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