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General NPI Number Information
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NPI Number | 1275218992
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Entity Type | Organization
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Legal Business Name | POTOMAC SPEECH AND LANGUAGE THERAPY LLC
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Dates
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Enumeration Date | 06/20/2023
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Last Update Date | 06/20/2023
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Provider Practice Location Address
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Address Line | 7708 RICHMOND HWY # 1010
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City | ALEXANDRIA
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State | VA
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Zip | 22306-2803
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Country | US
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Telephone | 484-638-3183
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Fax |
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Provider Business Mailing Address
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Address Line | 7708 RICHMOND HWY # 1010
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City | ALEXANDRIA
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State | VA
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Zip | 22306-2803
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Country | US
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Telephone | 484-638-3183
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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 | ERIN STAUDT
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Credential | MS, CCC-SLP
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Telephone | 484-638-3183
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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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