MEDICARE: PIEDMONT SPEECH THERAPY, INC

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	278286	OTHER	VA	ANTHEM BCBS

General Provider Information

NPI Number	:	1922105121
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PIEDMONT SPEECH THERAPY, INC

Provider Business Mailing Address
First Line	:	15421 FOREST RD
Second Line	:	SUITE D
City	:	FOREST
State	:	VA
Zip	:	24551-2274
Country	:	US
Telephone Number	:	434-525-2394
Fax Number	:	434-525-2118

Provider Business Practice Location Address
First Line	:	15421 FOREST RD
Second Line	:	SUITE D
City	:	FOREST
State	:	VA
Zip	:	24551-2274
Country	:	US
Telephone Number	:	434-525-2394
Fax Number	:	434-525-2118

Authorized Official
Title or Position	:	PATHOLOGIST
Name	:	KAREN S SIMS
Credential	:	M.ED,M.S.CCC-SLP
Telephone Number	:	434-525-2394

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	08/22/2020

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Directions to “PIEDMONT SPEECH THERAPY, INC ” Practice Location

Language	Start Address	Practice Location

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