Organization
SPEECHWORKS 4 KIDS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHANNON GONZALEZ M. A., CCC-SLP (PRESIDENT: SLP)
(478) 213-4604
Entity
Organization
Contact information
Practice address
12026 LAKE DORIAN DR, BRISTOW, VA 20136-6169
(478) 213-4604
(571) 379-8807
Mailing address
12026 LAKE DORIAN DR, BRISTOW, VA 20136-6169
(478) 213-4604
(571) 379-8807
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
2202006366
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1073946786
—
VA
Enumeration date
08/16/2013
Last updated
10/23/2014
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