Healthcare Provider Details

I. General information

NPI: 1609973270
Provider Name (Legal Business Name): CHILDREN'S SPEECH & LANGUAGE THERAPY CENTER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2006
Last Update Date: 07/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21660 RED RUM DR SUITE 105
ASHBURN VA
20147-5862
US

IV. Provider business mailing address

21660 RED RUM DR SUITE 105
ASHBURN VA
20147-5862
US

V. Phone/Fax

Practice location:
  • Phone: 703-858-7388
  • Fax:
Mailing address:
  • Phone: 703-858-7388
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MR. CURTIS L WATERS
Title or Position: OWNER
Credential:
Phone: 703-858-7388