=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871404707
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | POTOMAC RIVER CLINIC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/17/2026
-----------------------------------------------------
Last Update Date | 09/17/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4880 MACARTHUR BLVD NW
-----------------------------------------------------
City | WASHINGTON
-----------------------------------------------------
State | DC
-----------------------------------------------------
Zip | 20007-1557
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 202-333-1403
-----------------------------------------------------
Fax | 202-333-1404
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4880 MACARTHUR BLVD NW
-----------------------------------------------------
City | WASHINGTON
-----------------------------------------------------
State | DC
-----------------------------------------------------
Zip | 20007-1557
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 202-333-1403
-----------------------------------------------------
Fax | 202-333-1404
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | MEREDITH OUELLETTE
-----------------------------------------------------
Credential | SLP
-----------------------------------------------------
Telephone | 202-337-3554
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------