Individual
TAI MICHELLE GORECKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S.
Contact information
Practice address
1936 OPITZ BLVD, WOODBRIDGE, VA 22191-3360
(703) 687-5875
Mailing address
1936 OPITZ BLVD, WOODBRIDGE, VA 22191-3360
(703) 687-5875
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
2202008253
VA
Other
Enumeration date
07/20/2016
Last updated
07/20/2016
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