Provider Demographics
NPI:1376833525
Name:BRAIN MATTERS, PLLC
Entity Type:Organization
Organization Name:BRAIN MATTERS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST, OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:C
Authorized Official - Last Name:GALE
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP, CBIS
Authorized Official - Phone:703-362-5376
Mailing Address - Street 1:6120 BRANDON AVE
Mailing Address - Street 2:#315
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22150-2522
Mailing Address - Country:US
Mailing Address - Phone:703-362-5376
Mailing Address - Fax:703-560-7151
Practice Address - Street 1:6120 BRANDON AVE
Practice Address - Street 2:#315
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22150-2522
Practice Address - Country:US
Practice Address - Phone:703-362-5376
Practice Address - Fax:703-560-7151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-08
Last Update Date:2011-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202001032261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech