Provider Demographics
NPI:1619076601
Name:ELLEN EDWARDS, PLLC
Entity Type:Organization
Organization Name:ELLEN EDWARDS, PLLC
Other - Org Name:RESTON SPEECH & LANGUAGE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:703-904-8334
Mailing Address - Street 1:626 GRANT ST STE K
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170-4700
Mailing Address - Country:US
Mailing Address - Phone:703-904-8334
Mailing Address - Fax:703-904-8334
Practice Address - Street 1:626 GRANT ST STE K
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-4700
Practice Address - Country:US
Practice Address - Phone:703-904-8334
Practice Address - Fax:703-904-8334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202002947235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty