Provider Demographics
NPI:1568743219
Name:WASHINGTON SPEECH-LANGUAGE PATHOLOGY GROUP PLLC
Entity Type:Organization
Organization Name:WASHINGTON SPEECH-LANGUAGE PATHOLOGY GROUP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCPHEE
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-SLP
Authorized Official - Phone:703-537-0373
Mailing Address - Street 1:11150 FAIRFAX BLVD
Mailing Address - Street 2:SUITE 500
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-5066
Mailing Address - Country:US
Mailing Address - Phone:703-537-0373
Mailing Address - Fax:703-865-7379
Practice Address - Street 1:11150 FAIRFAX BLVD
Practice Address - Street 2:SUITE 500
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-5066
Practice Address - Country:US
Practice Address - Phone:703-537-0373
Practice Address - Fax:703-865-7379
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-07
Last Update Date:2015-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202006281235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty