Provider Demographics
NPI:1417267899
Name:PRINCE WILLIAM SPEECH AND HEARING CENTER, INC
Entity Type:Organization
Organization Name:PRINCE WILLIAM SPEECH AND HEARING CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR, SPEECH-LANGUAGE
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:HAROLD
Authorized Official - Last Name:NARBURGH
Authorized Official - Suffix:
Authorized Official - Credentials:MED, CCC SLP
Authorized Official - Phone:703-670-8126
Mailing Address - Street 1:4317 RIDGEWOOD CENTER DRIVE
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-5306
Mailing Address - Country:US
Mailing Address - Phone:703-670-8126
Mailing Address - Fax:703-670-0035
Practice Address - Street 1:4317 RIDGEWOOD CENTER DRIVE
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-5306
Practice Address - Country:US
Practice Address - Phone:703-670-8126
Practice Address - Fax:703-670-0035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-19
Last Update Date:2010-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech