Provider Demographics
NPI:1013120179
Name:SYNTACTICS LLC
Entity Type:Organization
Organization Name:SYNTACTICS LLC
Other - Org Name:SYNTACITICS SPEECH & LANGUAGE PATHOLOGY SERVICE
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER, CLINICAL DIRECTOR, SLP
Authorized Official - Prefix:DR
Authorized Official - First Name:GRACE
Authorized Official - Middle Name:
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, CCC-SLP
Authorized Official - Phone:703-729-6291
Mailing Address - Street 1:932 HUNGERFORD DRIVE
Mailing Address - Street 2:SUITE 29A
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-1752
Mailing Address - Country:US
Mailing Address - Phone:301-424-7701
Mailing Address - Fax:301-424-7703
Practice Address - Street 1:44081 PIPELINE PLZ STE 200
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147
Practice Address - Country:US
Practice Address - Phone:301-424-7701
Practice Address - Fax:301-424-7703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202004766235Z00000X
MD04742235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD831BSYOtherCAREFIRST BCBS
MD9350944OtherCIGNA
MDK515 0001OtherBCBS GHMSI
DCK515 0001OtherCAREFIRST BCBS