Provider Demographics
NPI:1710260229
Name:GREENMAN, GEOFFREY (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:GEOFFREY
Middle Name:
Last Name:GREENMAN
Suffix:
Gender:M
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7142 ELLISON ST
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22046-2008
Mailing Address - Country:US
Mailing Address - Phone:716-432-7505
Mailing Address - Fax:
Practice Address - Street 1:7142 ELLISON ST
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22046-2008
Practice Address - Country:US
Practice Address - Phone:716-432-7505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist