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General NPI Number Information
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NPI Number | 1205545795
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Entity Type | Organization
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Legal Business Name | PEEK-A-BOO SPEECH PLLC
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Dates
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Enumeration Date | 11/23/2022
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Last Update Date | 11/23/2022
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Provider Practice Location Address
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Address Line | 601 KING ST STE 201
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City | ALEXANDRIA
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State | VA
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Zip | 22314-3151
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Country | US
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Telephone | 571-989-3502
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Fax |
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Provider Business Mailing Address
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Address Line | 601 KING ST STE 201
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City | ALEXANDRIA
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State | VA
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Zip | 22314-3151
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Country | US
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Telephone | 571-989-3502
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Fax |
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Authorized Official
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Title or Position | SPEECH LANGUAGE PATHOLOGIST
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Name | VANESSA ANNE TALBOTT
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Credential |
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Telephone | 571-989-3502
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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 |
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License Number State |
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