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Organization
PEDIATRIC SPEECH LAB
Active
Organization
PEDIATRIC SPEECH LAB
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. QUINTINA MARIA BRISCOE M.S. CCC-SLP (SPEECH-LANGUAGE PATHOLOGIST/ OWNER)
(301) 885-0033
Entity
Organization
Contact information
Practice address
11350 PEMBROOKE SQ STE 313, WALDORF, MD 20603-4809
(301) 885-0033
Mailing address
11350 PEMBROOKE SQ STE 313, WALDORF, MD 20603-4809
(301) 885-0033
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
—
—
106E00000X
Assistant Behavior Analyst
—
—
235Z00000X
Speech-Language Pathologist
08341
MD
235Z00000X
Speech-Language Pathologist
Primary
SLP000879
DC
251S00000X
Community/Behavioral Health Agency
—
—
261QM1300X
Multi-Specialty Clinic/Center
—
—
Other
Enumeration date
01/17/2017
Last updated
09/01/2022
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