Basic Information
| Provider Information | |||||||||
| NPI: | 1497082176 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TRELLIS SERVICES, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 164 LAKE FRONT DR | ||||||||
| Address2: | |||||||||
| City: | HUNT VALLEY | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210302215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4107853845 | ||||||||
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| Practice Location | |||||||||
| Address1: | 164 LAKE FRONT DR | ||||||||
| Address2: | |||||||||
| City: | HUNT VALLEY | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210302215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4107853845 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/17/2009 | ||||||||
| LastUpdateDate: | 11/17/2009 | ||||||||
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| AuthorizedOfficialLastName: | GOODMAN-KESSLER | ||||||||
| AuthorizedOfficialFirstName: | JUNE | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR OF OUT PATIENT SERVICES | ||||||||
| AuthorizedOfficialTelephone: | 4107843845 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 04277 | MD | Y | 193400000X SINGLE SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.