Individual
PATRICIA S. PARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SLP
Contact information
Practice address
3750 JOSEPH SIEWICK DR, FAIRFAX, VA 22033-1742
(703) 391-1026
(703) 391-1027
Mailing address
9900 MAIN ST, SUITE 200A, FAIRFAX, VA 22031-3907
(703) 279-4394
(703) 279-4214
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
03053
MD
235Z00000X
Speech-Language Pathologist
Primary
2202-003368
VA
Other
Enumeration date
08/12/2005
Last updated
10/23/2010
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