Provider Demographics
NPI:1649393976
Name:THE SHIBBOLETH GROUP FOR SPEECH & LANGUAGE IMPROVEMENT, INC
Entity Type:Organization
Organization Name:THE SHIBBOLETH GROUP FOR SPEECH & LANGUAGE IMPROVEMENT, INC
Other - Org Name:THE SHIBBOLETH GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:S
Authorized Official - Last Name:KHABO
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-SLP
Authorized Official - Phone:202-271-1791
Mailing Address - Street 1:1701 LAWRENCE ST NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20018-3804
Mailing Address - Country:US
Mailing Address - Phone:202-271-1791
Mailing Address - Fax:202-832-9552
Practice Address - Street 1:1701 LAWRENCE ST NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20018-3804
Practice Address - Country:US
Practice Address - Phone:202-271-1791
Practice Address - Fax:202-832-9552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202003961235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty