Provider Demographics
NPI:1598979502
Name:LANGUAGE LEARNING CLASSROOM
Entity Type:Organization
Organization Name:LANGUAGE LEARNING CLASSROOM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:LEIGH
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:804-301-9321
Mailing Address - Street 1:5248 SCOTSGLEN DR
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059-5533
Mailing Address - Country:US
Mailing Address - Phone:804-301-9321
Mailing Address - Fax:804-418-7928
Practice Address - Street 1:5248 SCOTSGLEN DR
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23059-5533
Practice Address - Country:US
Practice Address - Phone:804-301-9321
Practice Address - Fax:804-418-7928
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202004379235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA208489OtherANTHEM BLUE CROSS SHIELD
VA208518OtherANTHEM BLUE CROSS SHIELD
VA208447OtherANTHEM BLUE CROSS SHEILD