Provider Demographics
NPI:1043581622
Name:BEYOND THE BASICS SPEECH & LANGUAGE THERAPY
Entity type:Organization
Organization Name:BEYOND THE BASICS SPEECH & LANGUAGE THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SPEECH PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:TAMEKA
Authorized Official - Middle Name:GABRIELLA
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-SLP
Authorized Official - Phone:301-322-1714
Mailing Address - Street 1:1400 MERCANTILE LN STE 250
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-5333
Mailing Address - Country:US
Mailing Address - Phone:301-322-1714
Mailing Address - Fax:
Practice Address - Street 1:1400 MERCANTILE LN STE 250
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:MD
Practice Address - Zip Code:20774-5333
Practice Address - Country:US
Practice Address - Phone:301-322-1714
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-13
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05242235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty