Provider Demographics
NPI:1902109770
Name:PEDIATRIC FEEDING & SPEECH SOLUTIONS, PLLC
Entity Type:Organization
Organization Name:PEDIATRIC FEEDING & SPEECH SOLUTIONS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:BENSON-VOGT
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC/SLP
Authorized Official - Phone:703-771-2200
Mailing Address - Street 1:704 S KING ST
Mailing Address - Street 2:SUITE # 1
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20175-3929
Mailing Address - Country:US
Mailing Address - Phone:703-771-2200
Mailing Address - Fax:703-771-7080
Practice Address - Street 1:704 S KING ST
Practice Address - Street 2:SUITE # 1
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20175-3929
Practice Address - Country:US
Practice Address - Phone:703-771-2200
Practice Address - Fax:703-771-7080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-16
Last Update Date:2010-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202004338235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1851420806OtherNPI