MEDICARE: EAT SPEAK PLAY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency	SLP00189	DC

General Provider Information

NPI Number	:	1023305240
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EAT SPEAK PLAY

Provider Business Mailing Address
First Line	:	46 MOUNT VERNON AVE
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22301-2321
Country	:	US
Telephone Number	:	703-828-7570
Fax Number	:

Provider Business Practice Location Address
First Line	:	46 MOUNT VERNON AVE
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22301-2321
Country	:	US
Telephone Number	:	703-828-7570
Fax Number	:

Authorized Official
Title or Position	:	SPEECH LANGUAGE PATHOLOGIST
Name	:	DEBORAH PERRY
Credential	:	MSR, CCC-SLP, ATP
Telephone Number	:	703-828-7570

Provider Enumeration Date	:	07/08/2011
Last Update Date	:	03/29/2012

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Directions to “EAT SPEAK PLAY ” Practice Location

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