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NPI Code Detail

MEDICARE: MRS. LYNN STAUBACH WILLIAMS M.A., CCC-SLP

MEDICARE: MRS. LYNN STAUBACH WILLIAMS M.A., CCC-SLP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1235Z00000XSpeech-Language Pathologist2202001064VA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12202001064OTHERVASTATE LICENSE

General Provider Information

NPI Number : 1427105519
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. LYNN STAUBACH WILLIAMS M.A., CCC-SLP
Provider Business Mailing Address
First Line : 8270 WILLOW OAKS CORPORATE DR STE 2127
Second Line :
City : FAIRFAX
State : VA
Zip : 22031-4511
Country : US
Telephone Number : 571-423-4171
Fax Number :
Provider Business Practice Location Address
First Line : 8270 WILLOW OAKS CORPORATE DR STE 2127
Second Line :
City : FAIRFAX
State : VA
Zip : 22031-4511
Country : US
Telephone Number : 571-423-4171
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/04/2007
Last Update Date : 12/05/2019

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