Healthcare Provider Details

I. General information

NPI: 1225388614
Provider Name (Legal Business Name): DKB SPEECH AND LANGUAGE SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2012
Last Update Date: 09/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 WESTWOOD OFFICE PARK
FREDERICKSBURG VA
22401-5121
US

IV. Provider business mailing address

810 WESTWOOD OFFICE PARK
FREDERICKSBURG VA
22401-5121
US

V. Phone/Fax

Practice location:
  • Phone: 540-693-6997
  • Fax: 877-771-3419
Mailing address:
  • Phone: 540-693-6997
  • Fax: 877-771-3419

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225CA2500X
TaxonomyAssistive Technology Supplier Rehabilitation Counselor
License Number
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code225CA2400X
TaxonomyAssistive Technology Practitioner Rehabilitation Counselor
License Number
License Number StateVA

VIII. Authorized Official

Name: DENIECE M PAYNE
Title or Position: CLINICAL DIRECTOR
Credential: MS, CCP-SLP
Phone: 540-693-6997