Individual
MARY L JACKSON SPEEDIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
707 N BROADWAY, BALTIMORE, MD 21205-1832
(443) 923-9200
(443) 923-9405
Mailing address
2931 E BIDDLE ST, PATIENT ACCOUNTING, BALTIMORE, MD 21213-3939
(443) 923-1886
(443) 923-1875
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
01655
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
36394001
CAREFIRST BC BS
MD
Enumeration date
04/02/2007
Last updated
07/08/2007
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