Provider Demographics
NPI:1134387145
Name:CORNERSTONE THERAPY CENTER & PRESCHOOL, LLC
Entity type:Organization
Organization Name:CORNERSTONE THERAPY CENTER & PRESCHOOL, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:JENIFER
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:SHOCKLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP, L
Authorized Official - Phone:703-327-5323
Mailing Address - Street 1:43453 PARISH ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH RIDING
Mailing Address - State:VA
Mailing Address - Zip Code:20152-2522
Mailing Address - Country:US
Mailing Address - Phone:703-327-5323
Mailing Address - Fax:703-327-5323
Practice Address - Street 1:43453 PARISH ST
Practice Address - Street 2:
Practice Address - City:SOUTH RIDING
Practice Address - State:VA
Practice Address - Zip Code:20152-2522
Practice Address - Country:US
Practice Address - Phone:703-327-5323
Practice Address - Fax:703-327-5323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-27
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202003982252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency