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General NPI Number Information
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NPI Number | 1013120179
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Entity Type | Organization
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Legal Business Name | SYNTACTICS LLC
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Dates
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Enumeration Date | 05/07/2007
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Last Update Date | 03/26/2019
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Provider Practice Location Address
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Address Line | 44081 PIPELINE PLZ STE 200
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City | ASHBURN
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State | VA
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Zip | 20147
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Country | US
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Telephone | 301-424-7701
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Fax | 301-424-7703
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Provider Business Mailing Address
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Address Line | 932 HUNGERFORD DRIVE SUITE 29A
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City | ROCKVILLE
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State | MD
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Zip | 20850-1752
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Country | US
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Telephone | 301-424-7701
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Fax | 301-424-7703
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Authorized Official
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Title or Position | OWNER, CLINICAL DIRECTOR, SLP
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Name | DR. GRACE PARK
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Credential | PH.D., CCC-SLP
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Telephone | 703-729-6291
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 2202004766
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License Number State | VA
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