Healthcare Provider Details

I. General information

NPI: 1053676460
Provider Name (Legal Business Name): CARALYN M WASNEECHAK M.S. SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CARALYN M LOPEZ M.S. SLP

II. Dates (important events)

Enumeration Date: 07/11/2012
Last Update Date: 01/21/2026
Certification Date: 01/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1421 KRISTINA WAY
CHESAPEAKE VA
23320-8917
US

IV. Provider business mailing address

717 SHADOWFIELD CT
CHESAPEAKE VA
23322-5873
US

V. Phone/Fax

Practice location:
  • Phone: 315-272-5771
  • Fax:
Mailing address:
  • Phone: 315-272-5771
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2202009207
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number022003-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: