Provider Demographics
NPI:1790391126
Name:PROFESSIONAL ADULT AND SCHOOL AGE SPEECH SERVICES LLC
Entity type:Organization
Organization Name:PROFESSIONAL ADULT AND SCHOOL AGE SPEECH SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALLANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-SLP
Authorized Official - Phone:540-222-1424
Mailing Address - Street 1:15792 BEAU RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22193-1028
Mailing Address - Country:US
Mailing Address - Phone:540-220-6194
Mailing Address - Fax:
Practice Address - Street 1:15792 BEAU RIDGE DR
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22193-1028
Practice Address - Country:US
Practice Address - Phone:540-222-1424
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-21
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty