Healthcare Provider Details

I. General information

NPI: 1871404707
Provider Name (Legal Business Name): POTOMAC RIVER CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4880 MACARTHUR BLVD NW
WASHINGTON DC
20007-1557
US

IV. Provider business mailing address

4880 MACARTHUR BLVD NW
WASHINGTON DC
20007-1557
US

V. Phone/Fax

Practice location:
  • Phone: 202-333-1403
  • Fax: 202-333-1404
Mailing address:
  • Phone: 202-333-1403
  • Fax: 202-333-1404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MEREDITH OUELLETTE
Title or Position: DIRECTOR
Credential: SLP
Phone: 202-337-3554