Healthcare Provider Details

I. General information

NPI: 1801786272
Provider Name (Legal Business Name): MEGHAN TIERNEY BEDFORD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2025
Last Update Date: 07/08/2025
Certification Date: 07/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3023 HAMAKER CT
FAIRFAX VA
22031-2207
US

IV. Provider business mailing address

111 MICHIGAN AVE NW
WASHINGTON DC
20010-2916
US

V. Phone/Fax

Practice location:
  • Phone: 703-280-3850
  • Fax:
Mailing address:
  • Phone: 202-476-5600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2204001645
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: