MEDICARE: MS. ALICIA ANTOINETTE KENT M.S., ED. CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	2202004492	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083638092
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ALICIA ANTOINETTE KENT M.S., ED. CCC-SLP

Provider Business Mailing Address
First Line	:	1348 GOOSE LNDG
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23451-6520
Country	:	US
Telephone Number	:	757-422-2357
Fax Number	:

Provider Business Practice Location Address
First Line	:	2135 GENERAL BOOTH BLVD
Second Line	:	SUITE 152
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23454-5881
Country	:	US
Telephone Number	:	757-430-8828
Fax Number	:	757-430-8189

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/26/2006
Last Update Date	:	07/08/2007

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Directions to “ MS. ALICIA ANTOINETTE KENT M.S., ED. CCC-SLP” Practice Location

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