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NPI Code Detail

MEDICARE: BETHANY FIRSTBROOK MA, CCC-SLP

MEDICARE: BETHANY FIRSTBROOK MA, 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
1235Z00000XSpeech-Language Pathologist06709MD

General Provider Information

NPI Number : 1831469576
Entity Type Code : Individual
Provider Name (Legal Business Name) : BETHANY FIRSTBROOK MA, CCC-SLP
Provider Business Mailing Address
First Line : 8230 BODKIN AVE
Second Line :
City : PASADENA
State : MD
Zip : 21122-4703
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3000 N RIDGE RD
Second Line :
City : ELLICOTT CITY
State : MD
Zip : 21043-3311
Country : US
Telephone Number : 410-461-7577
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/11/2012
Last Update Date : 01/11/2012

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Directions to “ BETHANY FIRSTBROOK MA, CCC-SLP” Practice Location

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