Healthcare Provider Details

I. General information

NPI: 1255114302
Provider Name (Legal Business Name): COLLABORATIVE SPEECH SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2023
Last Update Date: 08/14/2023
Certification Date: 08/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 CEDAR RD
POQUOSON VA
23662-2107
US

IV. Provider business mailing address

33 CEDAR RD
POQUOSON VA
23662-2107
US

V. Phone/Fax

Practice location:
  • Phone: 757-374-6772
  • Fax:
Mailing address:
  • Phone: 757-374-6772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA3000X
TaxonomyAugmentative Communication Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MRS. HEATHER LINNAE PATTON
Title or Position: SPEECH-LANGUAGE PATHOLOGIST
Credential: MS, CCC-SLP
Phone: 804-815-9417