Provider Demographics
NPI:1477793966
Name:PEDIATRICS FIRST SPEECH THERAPY
Entity Type:Organization
Organization Name:PEDIATRICS FIRST SPEECH THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/LEAD THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:GAYE
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:STEWART-TOOSON
Authorized Official - Suffix:
Authorized Official - Credentials:MACCC-SLP
Authorized Official - Phone:703-367-0400
Mailing Address - Street 1:12841 BRAEMAR VILLAGE PLAZA 132 BRISTOW
Mailing Address - Street 2:
Mailing Address - City:BRISTOW
Mailing Address - State:VA
Mailing Address - Zip Code:20136
Mailing Address - Country:US
Mailing Address - Phone:703-367-0400
Mailing Address - Fax:703-880-7411
Practice Address - Street 1:10056 PENTLAND HILLS WAY
Practice Address - Street 2:
Practice Address - City:BRISTOW
Practice Address - State:VA
Practice Address - Zip Code:20136
Practice Address - Country:US
Practice Address - Phone:703-367-0400
Practice Address - Fax:703-880-7411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-24
Last Update Date:2009-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202003950235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty