Provider Demographics
NPI:1649606369
Name:BECKMAN, EMILY OLIVIA (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:OLIVIA
Last Name:BECKMAN
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5585 CALLCOTT WAY UNIT 1082
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22312-4006
Mailing Address - Country:US
Mailing Address - Phone:507-720-4605
Mailing Address - Fax:
Practice Address - Street 1:11240 WAPLES MILL RD STE 202
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-6078
Practice Address - Country:US
Practice Address - Phone:703-237-2219
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-26
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202006972235Z00000X
MD07341235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist