MEDICARE: THE SHIBBOLETH GROUP FOR SPEECH & LANGUAGE IMPROVEMENT, INC

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	235Z00000X	Speech-Language Pathologist	2202003961	VA

General Provider Information

NPI Number	:	1649393976
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE SHIBBOLETH GROUP FOR SPEECH & LANGUAGE IMPROVEMENT, INC

Provider Business Mailing Address
First Line	:	1701 LAWRENCE ST NE
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20018-3804
Country	:	US
Telephone Number	:	202-271-1791
Fax Number	:	202-832-9552

Provider Business Practice Location Address
First Line	:	1701 LAWRENCE ST NE
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20018-3804
Country	:	US
Telephone Number	:	202-271-1791
Fax Number	:	202-832-9552

Authorized Official
Title or Position	:	PRESIDENT
Name	:	BEVERLY S. KHABO
Credential	:	CCC-SLP
Telephone Number	:	202-271-1791

Provider Enumeration Date	:	04/10/2007
Last Update Date	:	08/22/2020

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