Provider Demographics
NPI:1760501712
Name:CHILDREN'S SPEECH AND LANGUAGE SERVICES INC.
Entity Type:Organization
Organization Name:CHILDREN'S SPEECH AND LANGUAGE SERVICES INC.
Other - Org Name:CHILDREN'S SPEECH AND LANGUAGE SERVICES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:S
Authorized Official - Last Name:GAINES
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP, PCI
Authorized Official - Phone:703-685-1070
Mailing Address - Street 1:6231 LEESBURG PIKE
Mailing Address - Street 2:SUITE 520
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22044-2102
Mailing Address - Country:US
Mailing Address - Phone:703-685-1070
Mailing Address - Fax:703-685-0151
Practice Address - Street 1:6231 LEESBURG PIKE
Practice Address - Street 2:SUITE 520
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22044-2102
Practice Address - Country:US
Practice Address - Phone:703-685-1070
Practice Address - Fax:703-685-0151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202000517235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA115763OtherKAISER PERMANENTE HMO
VA2121915OtherMAMSI HMO
VA=========OtherTRICARE
VA=========OtherCAREFIRST BCBS