Healthcare Provider Details

I. General information

NPI: 1013364264
Provider Name (Legal Business Name): ALLISON HUTTENBRAUCK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2016
Last Update Date: 05/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 ARGYLL ST
CHESAPEAKE VA
23320-3105
US

IV. Provider business mailing address

929 SYDENHAM BLVD
CHESAPEAKE VA
23322-6818
US

V. Phone/Fax

Practice location:
  • Phone: 757-547-4528
  • Fax: 757-547-0632
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2202004165
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: