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General NPI Number Information
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NPI Number | 1144695180
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Entity Type | Individual
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Provider Name | OLGA GONCHAROV M.A., CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 12/02/2015
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Last Update Date | 12/02/2015
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Provider Practice Location Address
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Address Line | 43255 STILLFOREST TER.
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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 | 248-470-5774
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Fax |
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Provider Business Mailing Address
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Address Line | 43255 STILLFOREST TER
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City | ASHBURN
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State | VA
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Zip | 20147-5138
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Country | US
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Telephone | 248-470-5774
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 2202006930
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License Number State | VA
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