Basic Information
| Provider Information | |||||||||
| NPI: | 1164717724 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COULSON | ||||||||
| FirstName: | BIANCA | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.S., CCC-SLP | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | GRESCO | ||||||||
| OtherFirstName: | BIANCA | ||||||||
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| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 7310 RITCHIE HWY | ||||||||
| Address2: | STE 500 | ||||||||
| City: | GLEN BURNIE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210613065 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4107664047 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 7310 RITCHIE HWY | ||||||||
| Address2: | STE 500 | ||||||||
| City: | GLEN BURNIE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210613065 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4107664047 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/12/2011 | ||||||||
| LastUpdateDate: | 02/16/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 0214A | MD | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.