Basic Information
Provider Information
NPI: 1164689626
EntityType: 2
ReplacementNPI:  
OrganizationName: KENNEDY KRIEGER EDUCATION AND COMMUNITY SERVICES
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: KENNEDY KRIEGER SCHOOL
OtherOrganizationType: 3
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1741 ASHLAND AVE.
Address2:  
City: BALTIMORE
State: MD
PostalCode: 21205
CountryCode: US
TelephoneNumber: 4439231870
FaxNumber: 4439231895
Practice Location
Address1: 4600 POWDER MILL RD.
Address2:  
City: BELTSVILLE
State: MD
PostalCode: 207052675
CountryCode: US
TelephoneNumber: 4439234170
FaxNumber: 4439239405
Other Information
ProviderEnumerationDate: 05/21/2008
LastUpdateDate: 11/24/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: NEUMAN
AuthorizedOfficialFirstName: MICHAEL
AuthorizedOfficialMiddleName: J
AuthorizedOfficialTitleorPosition: SENIOR VP FINANCE
AuthorizedOfficialTelephone: 4439231810
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: MR.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 11/24/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YS0200X MDN193200000X MULTI-SPECIALTY GROUPBehavioral Health & Social Service ProvidersCounselorSchool
163WS0200X MDN193200000X MULTI-SPECIALTY GROUPNursing Service ProvidersRegistered NurseSchool
225100000X MDN193200000X MULTI-SPECIALTY GROUPRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 
225X00000X MDN193200000X MULTI-SPECIALTY GROUPRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist 
235Z00000X MDN193200000X MULTI-SPECIALTY GROUPSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist 
261QD1600X30-036MDY Ambulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities

No ID Information.


Home