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General NPI Number Information
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NPI Number | 1669758843
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Entity Type | Organization
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Legal Business Name | PLAYWORKS SPEECH THERAPY, PLLC
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Dates
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Enumeration Date | 11/01/2011
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Last Update Date | 11/01/2011
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Provider Practice Location Address
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Address Line | 4931 OLD DOMINION DR
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City | ARLINGTON
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State | VA
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Zip | 22207-2833
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Country | US
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Telephone | 703-623-1806
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Fax | 703-241-1910
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Provider Business Mailing Address
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Address Line | 4931 OLD DOMINION DR
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City | ARLINGTON
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State | VA
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Zip | 22207-2833
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Country | US
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Telephone | 703-623-1806
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Fax | 703-241-1910
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Authorized Official
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Title or Position | SPEECH LANGUAGE PATHOLOGIST
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Name | MRS. PATRICIA SHANAHAN WILSON
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Credential | M.S., CCC-SLP
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Telephone | 703-623-1806
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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 | 2202004319
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License Number State | VA
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