Provider Demographics
NPI:1750618187
Name:DODD, THERESA MARIE (THERESA DODD, MA)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:MARIE
Last Name:DODD
Suffix:
Gender:F
Credentials:THERESA DODD, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3535 S BALL ST
Mailing Address - Street 2:APT. 206
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22202-4426
Mailing Address - Country:US
Mailing Address - Phone:908-507-6481
Mailing Address - Fax:571-633-9666
Practice Address - Street 1:1495 CHAIN BRIDGE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-5727
Practice Address - Country:US
Practice Address - Phone:571-633-0770
Practice Address - Fax:571-633-9666
Is Sole Proprietor?:No
Enumeration Date:2009-11-05
Last Update Date:2009-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202005916235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist