Pediatric Speech Lab

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

SLP000879 Issued in DC

Legal business name

PEDIATRIC SPEECH LAB

Practice address

11350 Pembrooke SQ Ste 313
Waldorf, MD 20603-4809

Phone

(301) 885-0033

NPI assigned

Jan 17, 2017

Organization subpart

No

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

Authorized official

Name

Ms. Quintina Maria Briscoe, M.S. CCC-SLPNPI 1902226988

Title

Speech-Language Pathologist/ Owner

Phone

(301) 885-0033

Specialties & licenses 6

Addresses

Medicare fee-for-service enrollment

Enrolled in MD

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Quintina Maria Briscoe, CCC-SLP

  • Speech-Language Pathologist
  • Waldorf, MD
  • NPI 1902226988
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1484611200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1661990400000",
    "number": "1720524598",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11350 PEMBROOKE SQ STE 313",
            "city": "WALDORF",
            "state": "MD",
            "postal_code": "206034809",
            "telephone_number": "301-885-0033"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11350 PEMBROOKE SQ STE 313",
            "city": "WALDORF",
            "state": "MD",
            "postal_code": "206034809",
            "telephone_number": "301-885-0033"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEDIATRIC SPEECH LAB",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-01-17",
        "last_updated": "2022-09-01",
        "certification_date": "2022-08-19",
        "status": "A",
        "authorized_official_last_name": "BRISCOE",
        "authorized_official_first_name": "QUINTINA",
        "authorized_official_middle_name": "MARIA",
        "authorized_official_title_or_position": "SPEECH-LANGUAGE PATHOLOGIST/ OWNER",
        "authorized_official_telephone_number": "301-885-0033",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "M.S. CCC-SLP"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "106E00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Assistant Behavior Analyst",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": "DC",
            "license": "SLP000879",
            "primary": true
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": "MD",
            "license": "08341",
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Janine Peacock, D.P.T.
• Michael Edward Pearlman, DPM
• Jessica Peck, PSYD
• Pediatric Partners of Southern Maryland, PA
• Pediatric Speech Lab (Speech Lab ABA)
• Pembrooke Anesthesia Assoc., LLC
• Pembrooke Health Services LLC (Pembrooke Pharmacy)
• Pembrooke Square ENT Associates, LLC
• Pembrooke Square Surgery Center, LLC
• Tina Lorice Penny

• Speech-Language Pathologist in Waldorf, MD
• Providers in Waldorf, 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 1, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.