Provider Demographics
NPI:1558304253
Name:BLUE RIDGE SPEECH & HEARING CENTER OF LOUDOUN COUNTY, INC.
Entity Type:Organization
Organization Name:BLUE RIDGE SPEECH & HEARING CENTER OF LOUDOUN COUNTY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHARLOTTE
Authorized Official - Middle Name:
Authorized Official - Last Name:FOSQUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-858-7620
Mailing Address - Street 1:19465 DEERFIELD AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LANSDOWNE
Mailing Address - State:VA
Mailing Address - Zip Code:20176-8446
Mailing Address - Country:US
Mailing Address - Phone:703-858-7620
Mailing Address - Fax:703-858-7657
Practice Address - Street 1:19465 DEERFIELD AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:LANSDOWNE
Practice Address - State:VA
Practice Address - Zip Code:20176-8446
Practice Address - Country:US
Practice Address - Phone:703-858-7620
Practice Address - Fax:703-858-7657
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Single Specialty
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA4978196Medicaid
VA4978196Medicaid
VAC06959Medicare PIN