Healthcare Provider Details

I. General information

NPI: 1205443363
Provider Name (Legal Business Name): HERDEWE EDUCATIONAL AUDIOLOGY AND SPEECH LANGUAGE SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2020
Last Update Date: 09/23/2020
Certification Date: 08/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

283 W MAIN ST
COVINGTON VA
24426-1542
US

IV. Provider business mailing address

283 W MAIN ST
COVINGTON VA
24426-1542
US

V. Phone/Fax

Practice location:
  • Phone: 540-968-0100
  • Fax:
Mailing address:
  • Phone: 540-968-0100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number
License Number State

VIII. Authorized Official

Name: DR. GARY L. PILLOW
Title or Position: PRESIDENT/AUDIOLOGIST
Credential: AU.D.,ED.D.
Phone: 540-968-0100