Healthcare Provider Details

I. General information

NPI: 1679993612
Provider Name (Legal Business Name): CHILDREN'S NATIONAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2014
Last Update Date: 04/17/2014
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: 202-476-2163
  • Fax:
Mailing address:
  • Phone: 202-476-2163
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code282NC2000X
TaxonomyChildren's Hospital
License Number07505
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code282NC2000X
TaxonomyChildren's Hospital
License Number2202007301
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code282NC2000X
TaxonomyChildren's Hospital
License NumberSPL000527
License Number StateDC

VIII. Authorized Official

Name: MISS MAURA COLLINS
Title or Position: SPEECH-LANGUAGE PATHOLOGIST
Credential: M.S, CCC- SLP
Phone: 202-476-5600