MEDICARE: THERESA MARIE DODD THERESA DODD, M.A.

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	2202005916	VA

General Provider Information

NPI Number	:	1750618187
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THERESA MARIE DODD THERESA DODD, M.A.

Provider Business Mailing Address
First Line	:	3535 S BALL ST
Second Line	:	APT. 206
City	:	ARLINGTON
State	:	VA
Zip	:	22202-4426
Country	:	US
Telephone Number	:	908-507-6481
Fax Number	:	571-633-9666

Provider Business Practice Location Address
First Line	:	1495 CHAIN BRIDGE RD
Second Line	:	SUITE 100
City	:	MC LEAN
State	:	VA
Zip	:	22101-5727
Country	:	US
Telephone Number	:	571-633-0770
Fax Number	:	571-633-9666

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/05/2009
Last Update Date	:	11/05/2009

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