Provider Demographics
NPI:1609049477
Name:TOTS TO TEENS THERAPY SERVICES
Entity type:Organization
Organization Name:TOTS TO TEENS THERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:DUNCAN
Authorized Official - Last Name:RUCKNER
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:703-507-1533
Mailing Address - Street 1:12263 CHARLES LACEY DR.
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20112
Mailing Address - Country:US
Mailing Address - Phone:703-507-1533
Mailing Address - Fax:
Practice Address - Street 1:5880 MOONBEAM DR
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22193-6009
Practice Address - Country:US
Practice Address - Phone:703-507-1533
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-11
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty