Healthcare Provider Details

I. General information

NPI: 1639094089
Provider Name (Legal Business Name): MS. MIRANDA HOPE KRESS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11101 MILL RD
GLEN ALLEN VA
23060-5004
US

IV. Provider business mailing address

2210 MANLYN RD
HENRICO VA
23229-3850
US

V. Phone/Fax

Practice location:
  • Phone: 304-476-1730
  • Fax:
Mailing address:
  • Phone: 304-476-1730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2204001853
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: