MEDICARE: CHANTILLY SPEECH THERAPY, LLC

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

General Provider Information

NPI Number	:	1801742705
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHANTILLY SPEECH THERAPY, LLC

Provider Business Mailing Address
First Line	:	42377 PINE FOREST DR
Second Line	:
City	:	CHANTILLY
State	:	VA
Zip	:	20152-6091
Country	:	US
Telephone Number	:	703-963-1564
Fax Number	:

Provider Business Practice Location Address
First Line	:	42377 PINE FOREST DR
Second Line	:
City	:	CHANTILLY
State	:	VA
Zip	:	20152-6091
Country	:	US
Telephone Number	:	703-963-1564
Fax Number	:

Authorized Official
Title or Position	:	OWNER/ SLP
Name	:	MS. CARLIE LOUINE PARKINSON MADSEN
Credential	:	MS, CCC-SLP
Telephone Number	:	703-963-1564

Provider Enumeration Date	:	03/05/2026
Last Update Date	:	03/05/2026

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Directions to “CHANTILLY SPEECH THERAPY, LLC ” Practice Location

Language	Start Address	Practice Location

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