Kids' Village Therapy, LLC

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

Legal business name

KIDS' VILLAGE THERAPY, LLC

Practice address

5060 Dorsey Hall Dr
Suite 204
Ellicott City, MD 21042-7884

Phone

(443) 283-0618

Fax

(443) 283-0347

NPI assigned

Sep 25, 2009

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dana Cheryl Mason, M.A., SLP

Title

Speech Language Pathologist

Phone

(443) 283-0618

Specialties & licenses 3

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1253836800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1253836800000",
    "number": "1104150986",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5060 DORSEY HALL DR",
            "address_2": "SUITE 204",
            "city": "ELLICOTT CITY",
            "state": "MD",
            "postal_code": "210427884",
            "telephone_number": "443-283-0618",
            "fax_number": "443-283-0347"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5060 DORSEY HALL DR",
            "address_2": "SUITE 204",
            "city": "ELLICOTT CITY",
            "state": "MD",
            "postal_code": "210427884",
            "telephone_number": "443-283-0618",
            "fax_number": "443-283-0347"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIDS' VILLAGE THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-09-25",
        "last_updated": "2009-09-25",
        "status": "A",
        "authorized_official_last_name": "MASON",
        "authorized_official_first_name": "DANA",
        "authorized_official_middle_name": "CHERYL",
        "authorized_official_title_or_position": "SPEECH LANGUAGE PATHOLOGIST",
        "authorized_official_telephone_number": "443-283-0618",
        "authorized_official_credential": "M.A., SLP"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225XP0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist, Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Speech-Language Pathologist in Ellicott City, MD
• Providers in Ellicott City, MD by specialty
• Speech-Language Pathologist in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.