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General NPI Number Information
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NPI Number | 1750170882
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Entity Type | Organization
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Legal Business Name | THIRD SPACE SPEECH AND LANGUAGE THERAPY PLLC
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Dates
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Enumeration Date | 05/05/2025
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Last Update Date | 05/05/2025
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Provider Practice Location Address
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Address Line | 1201 S EADS ST APT 808
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City | ARLINGTON
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State | VA
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Zip | 22202-2840
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Country | US
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Telephone | 703-964-6522
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Fax |
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Provider Business Mailing Address
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Address Line | 1201 S EADS ST APT 808
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City | ARLINGTON
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State | VA
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Zip | 22202-2840
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Country | US
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Telephone | 703-964-6522
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | ARIEL GIBBERMAN
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Credential | MA CCC-SLP
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Telephone | 703-964-6522
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0700X
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Taxonomy Name | Hearing and Speech Clinic/Center
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License Number |
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License Number State |
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