Healthcare Provider Details

I. General information

NPI: 1891098208
Provider Name (Legal Business Name): ALICIA S. QUINN-HOUSTON MA CCC SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2010
Last Update Date: 09/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 OAK ST
FARMVILLE VA
23901-1199
US

IV. Provider business mailing address

800 OAK STREET
FARMVILLE VA
23901
US

V. Phone/Fax

Practice location:
  • Phone: 434-318-2920
  • Fax:
Mailing address:
  • Phone: 434-315-2920
  • Fax: 434-315-2925

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2202005060
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: