Provider Demographics
NPI:1366057408
Name:BARRETT, DOMINIQUE (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:DOMINIQUE
Middle Name:
Last Name:BARRETT
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 E WEST HWY APT 341
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20782-2180
Mailing Address - Country:US
Mailing Address - Phone:817-896-9587
Mailing Address - Fax:
Practice Address - Street 1:5801 ALLENTOWN RD STE 410
Practice Address - Street 2:
Practice Address - City:CAMP SPRINGS
Practice Address - State:MD
Practice Address - Zip Code:20746-4565
Practice Address - Country:US
Practice Address - Phone:301-238-4788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-15
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD09819235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist