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General NPI Number Information
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NPI Number | 1629781844
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Entity Type | Organization
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Legal Business Name | EARLY SPEECH PRO LLC
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Dates
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Enumeration Date | 01/03/2023
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Last Update Date | 01/03/2023
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Provider Practice Location Address
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Address Line | 25 CATOCTIN CIR SE UNIT 4042
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City | LEESBURG
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State | VA
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Zip | 20175-3625
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Country | US
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Telephone | 703-261-9283
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Fax |
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Provider Business Mailing Address
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Address Line | 25 CATOCTIN CIR SE UNIT 4042
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City | LEESBURG
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State | VA
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Zip | 20175-3625
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Country | US
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Telephone | 703-261-9283
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Fax |
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Authorized Official
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Title or Position | SPEECH AND LANGUAGE PATHOLOGIST
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Name | SHEEBA RACHEL KOSHY
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Credential | SLP, MS CCC
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Telephone | 845-206-8666
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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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