Provider Demographics
NPI:1710504378
Name:O'BRIEN, EMILY (MS CF SLP)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:O'BRIEN
Suffix:
Gender:F
Credentials:MS CF SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11150 FAIRFAX BLVD STE 500
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-5029
Mailing Address - Country:US
Mailing Address - Phone:703-537-0373
Mailing Address - Fax:
Practice Address - Street 1:11150 FAIRFAX BLVD STE 500
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-5029
Practice Address - Country:US
Practice Address - Phone:703-537-0373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-30
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA22040000438235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist