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General NPI Number Information
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NPI Number | 1245589407
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Entity Type | Organization
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Legal Business Name | SPEECH THERAPISTS OF OLD TOWN
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Dates
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Enumeration Date | 09/04/2012
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Last Update Date | 09/04/2012
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Provider Practice Location Address
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Address Line | 700 PRINCESS ST #202
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City | ALEXANDRIA
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State | VA
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Zip | 22314-2268
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Country | US
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Telephone | 703-535-7841
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Fax | 703-535-7842
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Provider Business Mailing Address
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Address Line | 700 PRINCESS ST #202
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City | ALEXANDRIA
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State | VA
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Zip | 22314-2268
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Country | US
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Telephone | 703-535-7841
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Fax | 703-535-7842
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Authorized Official
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Title or Position | OWNER
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Name | MRS. JENNIFER R. LAFRENIERE
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Credential | MA CCC-SLP
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Telephone | 703-535-7841
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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 | 2202003958
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License Number State | VA
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