Provider Demographics
NPI:1669012803
Name:SPEECH AND LANGUAGE CENTER OF NORTHERN VIRGINIA
Entity Type:Organization
Organization Name:SPEECH AND LANGUAGE CENTER OF NORTHERN VIRGINIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF SPEECH-LANGUAGE SERVICE
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:THERESA
Authorized Official - Last Name:LYONS
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP
Authorized Official - Phone:703-356-2833
Mailing Address - Street 1:1125 SAVILE LN
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-1833
Mailing Address - Country:US
Mailing Address - Phone:571-331-2855
Mailing Address - Fax:
Practice Address - Street 1:1125 SAVILE LN
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-1833
Practice Address - Country:US
Practice Address - Phone:571-331-2855
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-15
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech