Healthcare Provider Details

I. General information

NPI: 1548413933
Provider Name (Legal Business Name): CHILDREN'S HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2008
Last Update Date: 10/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 MICHIGAN AVE NW
WASHINGTON DC
20010-2916
US

IV. Provider business mailing address

111 MICHIGAN AVE NW
WASHINGTON DC
20010-2916
US

V. Phone/Fax

Practice location:
  • Phone: 202-476-5600
  • Fax:
Mailing address:
  • Phone: 202-476-5600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number00474
License Number StateMD

VIII. Authorized Official

Name: MS. JOAN H. LACOSS
Title or Position: AUDIOLOGIST
Credential: M.A., CCC-A
Phone: 301-765-5400