NPIMap

Organization Active NPI

Milestone Masters Pediatric Therapy Inc

  • Speech-Language Pathologist
  • Annandale, VA
National Provider Identifier
1104503481
Registry record updated Oct 16, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
Legal business name
MILESTONE MASTERS PEDIATRIC THERAPY INC
Practice address
3543 Ewell St
Annandale, VA 22003-1708
Phone
(703) 509-6109
NPI assigned
Jun 29, 2023
Last updated
Oct 16, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 16, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Lauren Michelle Lyons, M. ED., CCC-SLP
Title
President
Phone
(703) 509-6109

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225X00000X
Speech-Language PathologistGroup: 193200000X MULTI-SPECIALTY GROUP 235Z00000X Primary

Addresses

Primary practice location

3543 Ewell St
Annandale, VA 22003-1708

Mailing address

3543 Ewell St
Annandale, VA 22003-1708
Phone (703) 509-6109

National Provider Directory

National Provider Directory

Locations

7010 Little River Tpke
Ste 115
Annandale, VA 22003
Phone (703) 424-0550

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1687996800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1697414400000",
    "number": "1104503481",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3543 EWELL ST",
            "city": "ANNANDALE",
            "state": "VA",
            "postal_code": "220031708",
            "telephone_number": "703-509-6109"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3543 EWELL ST",
            "city": "ANNANDALE",
            "state": "VA",
            "postal_code": "220031708",
            "telephone_number": "703-509-6109"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MILESTONE MASTERS PEDIATRIC THERAPY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-06-29",
        "last_updated": "2023-10-16",
        "certification_date": "2023-10-16",
        "status": "A",
        "authorized_official_last_name": "LYONS",
        "authorized_official_first_name": "LAUREN",
        "authorized_official_middle_name": "MICHELLE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "703-509-6109",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "M. ED., CCC-SLP"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Annandale, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.