| Pediatric Speech Lab | |
|
11350 Pembrooke Sq Ste 313 Waldorf MD 20603-4809 | |
| (301) 885-0033 | |
| Not Available |
| Full Name | Pediatric Speech Lab |
|---|---|
| Speciality | Speech-Language Pathologist |
| Location | 11350 Pembrooke Sq Ste 313, Waldorf, Maryland |
| Authorized Official Name and Position | Quintina Maria Briscoe (SPEECH-LANGUAGE PATHOLOGIST/ OWNER) |
| Authorized Official Contact | 3018850033 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pediatric Speech Lab 11350 Pembrooke Sq Ste 313 Waldorf MD 20603-4809 Ph: (301) 885-0033 | Pediatric Speech Lab 11350 Pembrooke Sq Ste 313 Waldorf MD 20603-4809 Ph: (301) 885-0033 |
| NPI Number | 1720524598 |
|---|---|
| Provider Enumeration Date | 01/17/2017 |
| Last Update Date | 09/01/2022 |
| Certification Date | 08/19/2022 |
| Medicare PECOS PAC ID | 3577994375 |
|---|---|
| Medicare Enrollment ID | O20200512000227 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720524598 | NPI | - | NPPES |
| Provider Name | Quintina Briscoe |
|---|---|
| Provider Type | Practitioner - Qualified Speech Language Pathologist |
| Provider Identifiers | NPI Number: 1902226988 PECOS PAC ID: 8628409422 Enrollment ID: I20200512000443 |
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