Healthcare Provider Details

I. General information

NPI: 1457546780
Provider Name (Legal Business Name): TIA NICOLE FRIEDMAN M.A. CFY-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TIA NICOLE HORN M.A. CFY-SLP

II. Dates (important events)

Enumeration Date: 09/10/2007
Last Update Date: 08/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4016 RAINTREE RD SUITE 240
CHESAPEAKE VA
23321-3700
US

IV. Provider business mailing address

4016 RAINTREE RD SUITE 240
CHESAPEAKE VA
23321-3700
US

V. Phone/Fax

Practice location:
  • Phone: 757-488-2864
  • Fax: 757-488-4735
Mailing address:
  • Phone: 757-488-2864
  • Fax: 757-488-4735

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberSZ4309
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2202005784
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: