Provider Demographics
NPI:1518307750
Name:METZGER GILBERT, KIRSTEN (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:
Last Name:METZGER GILBERT
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 W BROAD ST
Mailing Address - Street 2:#215
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22046-3340
Mailing Address - Country:US
Mailing Address - Phone:703-533-8819
Mailing Address - Fax:
Practice Address - Street 1:450 W BROAD ST
Practice Address - Street 2:#215
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22046-3340
Practice Address - Country:US
Practice Address - Phone:703-533-8819
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-02
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA22-2004537235Z00000X
DCSLP000143235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist