Provider Demographics
NPI:1144049479
Name:GRESHAM, GAMMON EDWARD (SLPA)
Entity type:Individual
Prefix:
First Name:GAMMON
Middle Name:EDWARD
Last Name:GRESHAM
Suffix:
Gender:M
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1119 STATE ROUTE 3 N STE 201
Mailing Address - Street 2:
Mailing Address - City:GAMBRILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21054-1788
Mailing Address - Country:US
Mailing Address - Phone:443-808-1218
Mailing Address - Fax:443-308-2111
Practice Address - Street 1:2300 SMALLWOOD DR W
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20603-4447
Practice Address - Country:US
Practice Address - Phone:301-753-1769
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-03
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD00918A2355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant