Provider Demographics
NPI:1114189404
Name:CHESAPEAKE HEALTH SERVICES, LLC
Entity Type:Organization
Organization Name:CHESAPEAKE HEALTH SERVICES, LLC
Other - Org Name:CHESAPEAKE CHILDREN'S THERAPY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:703-924-4100
Mailing Address - Street 1:6506 LOISDALE RD
Mailing Address - Street 2:STE 302
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22150-1824
Mailing Address - Country:US
Mailing Address - Phone:703-924-4100
Mailing Address - Fax:703-924-0214
Practice Address - Street 1:6506 LOISDALE RD
Practice Address - Street 2:STE 302
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22150-1824
Practice Address - Country:US
Practice Address - Phone:703-924-4100
Practice Address - Fax:703-924-0214
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-27
Last Update Date:2013-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202000563235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty