Healthcare Provider Details

I. General information

NPI: 1821520180
Provider Name (Legal Business Name): KERILYN M ISLEY M.S., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KERILYN MICHELLE CLAXTON M.S., CCC-SLP

II. Dates (important events)

Enumeration Date: 03/28/2017
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9421 GUM FORK RD
MIDLOTHIAN VA
23112-1420
US

IV. Provider business mailing address

3505 JONWARN CT
POWHATAN VA
23139-7117
US

V. Phone/Fax

Practice location:
  • Phone: 804-314-6588
  • Fax:
Mailing address:
  • Phone: 804-677-7026
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2202004455
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: