Healthcare Provider Details

I. General information

NPI: 1417239062
Provider Name (Legal Business Name): TJH SPEECH THERAPY SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2011
Last Update Date: 09/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 PELHAM WAY
STAFFORD VA
22556
US

IV. Provider business mailing address

36 PELHAM WAY
STAFFORD VA
22556
US

V. Phone/Fax

Practice location:
  • Phone: 240-291-6200
  • Fax: 540-659-2864
Mailing address:
  • Phone: 240-291-6200
  • Fax: 540-659-2864

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2202002066
License Number StateVA

VIII. Authorized Official

Name: MRS. TOBI JOHNSON HARDEN
Title or Position: SPEECH-LANGUAGE PATHOLOGIST/OWNER
Credential: M.S. CCC-SLP
Phone: 240-291-6200