Provider Demographics
NPI:1376768457
Name:MAXWELL, LINDA
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:MAXWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:
Other - Last Name:COMETTO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10420 RIFLE RD
Mailing Address - Street 2:
Mailing Address - City:BRISTOW
Mailing Address - State:VA
Mailing Address - Zip Code:20136-1329
Mailing Address - Country:US
Mailing Address - Phone:703-869-3748
Mailing Address - Fax:
Practice Address - Street 1:1850 CAMERON GLEN DR
Practice Address - Street 2:SUITE 100
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-3363
Practice Address - Country:US
Practice Address - Phone:703-481-4237
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202002788235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist