Individual provider Active NPI

Breanna Gardner

  • Speech-Language Pathologist
  • Arlington, VA
National Provider Identifier
1649897679
Registry record updated Mar 22, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
Practice address
900 N Taylor St
Arlington, VA 22203-1858
Phone
(703) 516-9455
NPI assigned
Jun 25, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 22, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X Primary

Addresses

Primary practice location

900 N Taylor St
Arlington, VA 22203-1858

Mailing address

14404 Woodmore Oaks CT
Bowie, MD 20721-3012
Phone (916) 826-0972

Other practice location 1

5910 Wilson Blvd
Arlington, VA 22205-1554
Phone (703) 536-1060

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC, VA, MD3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20220411002611 DC Practitioner - Qualified Speech Language Pathologist 7315333754 Reassigns benefits to 3 organizations
I20220415000698 VA Practitioner - Qualified Speech Language Pathologist 7315333754 Reassigns benefits to 1 organization
I20240725000912 MD Practitioner - Qualified Speech Language Pathologist 7315333754 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Qualified Speech Language Pathologist
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Comprehensive Therapeutics LTDGroup PAC ID 8921230137, 324 clinicians

Practice addresses (Care Compare)

2620 Main Line Blvd
Alexandria, VA 22301-3081
Phone (571) 531-9038

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
10911MDMDOrthodontics and Dentofacial Orthopedic Dentist

Practice roles

OrganizationSpecialtyStatusNew patients
Healthpro Heritage Rehab & Fitness, LLC Speech-Language Pathologist CurrentSince May 19, 2024 Accepting new patients
Fox Rehab SLP MD LLC Speech-Language Pathologist CurrentSince Jul 1, 2024 Accepting new patients
Comprehensive Therapeutics LTD Speech-Language Pathologist CurrentSince Mar 4, 2022 Accepting new patients
Fox Rehabilitation Services LLC CurrentSince Jul 1, 2024 Accepting new patients
Comprehensive Therapeutics LTD Speech-Language Pathologist CurrentSince Mar 4, 2022 Accepting new patients
Healthpro Heritage Rehab & Fitness, LLC Speech-Language Pathologist CurrentSince May 19, 2024 Accepting new patients

Locations

11665 Doolittle Dr
Waldorf, MD 20602
Phone (301) 638-4100

7 Carnegie Plz
Cherry Hill, NJ 08003

900 N Taylor St
Arlington, VA 22203
Phone (703) 516-9455

10286 Brook Rd
Glen Allen, VA 23059
Phone (571) 200-6617

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1593043200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1647907200000",
    "number": "1649897679",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14404 WOODMORE OAKS CT",
            "city": "BOWIE",
            "state": "MD",
            "postal_code": "207213012",
            "telephone_number": "916-826-0972"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 N TAYLOR ST",
            "city": "ARLINGTON",
            "state": "VA",
            "postal_code": "222031858",
            "telephone_number": "703-516-9455"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5910 Wilson Blvd",
            "address_purpose": "LOCATION",
            "city": "Arlington",
            "state": "VA",
            "postal_code": "222051554",
            "country_code": "US",
            "telephone_number": "703-536-1060",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GARDNER",
        "first_name": "BREANNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-06-25",
        "last_updated": "2022-03-22",
        "certification_date": "2022-03-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Arlington, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.