Provider Demographics
NPI:1033230545
Name:CHILDREN'S SPEECH AND LANGUAGE SERVICES OF SPRINGFIELD, LLC
Entity Type:Organization
Organization Name:CHILDREN'S SPEECH AND LANGUAGE SERVICES OF SPRINGFIELD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:GINNY
Authorized Official - Middle Name:
Authorized Official - Last Name:HEMMER
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP
Authorized Official - Phone:703-866-0344
Mailing Address - Street 1:6354 ROLLING MILL PL # 103
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22152-2354
Mailing Address - Country:US
Mailing Address - Phone:703-866-0344
Mailing Address - Fax:703-866-0233
Practice Address - Street 1:6354 ROLLING MILL PL # 103
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22152-2354
Practice Address - Country:US
Practice Address - Phone:703-866-0344
Practice Address - Fax:703-866-0233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA00001788235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA235Z00000XOtherSPEECH LANGUAGE PATHOLOGY