Provider Demographics
NPI:1750170882
Name:THIRD SPACE SPEECH AND LANGUAGE THERAPY PLLC
Entity type:Organization
Organization Name:THIRD SPACE SPEECH AND LANGUAGE THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ARIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GIBBERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MA CCC-SLP
Authorized Official - Phone:703-964-6522
Mailing Address - Street 1:1201 S EADS ST APT 808
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22202-2840
Mailing Address - Country:US
Mailing Address - Phone:703-964-6522
Mailing Address - Fax:
Practice Address - Street 1:1201 S EADS ST APT 808
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22202-2840
Practice Address - Country:US
Practice Address - Phone:703-964-6522
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-05
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech