Individual
TIARA BOOTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SLP
Contact information
Practice address
2900 CAMPUS WAY N, LANHAM, MD 20706-2892
(301) 276-9153
Mailing address
2900 CAMPUS WAY N, LANHAM, MD 20706-2892
(301) 276-9153
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
01818L
MD
235Z00000X
Speech-Language Pathologist
Primary
09346
MD
235Z00000X
Speech-Language Pathologist
2202010198
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01818L
STATE DEPARTMENT OF HEALTH
MD
01
—
09346
STATE DEPARTMENT OF HEALTH
MD
01
—
2202010198
STATE DEPARTMENT OF HEALTH
VA
Enumeration date
01/15/2020
Last updated
10/27/2021
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