Healthcare Provider Details

I. General information

NPI: 1659163392
Provider Name (Legal Business Name): KIDS COLLAB SPEECH AND LANGUAGE SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2025
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8401 MAYLAND DR STE S
RICHMOND VA
23294-4648
US

IV. Provider business mailing address

8401 MAYLAND DR STE S
RICHMOND VA
23294-4648
US

V. Phone/Fax

Practice location:
  • Phone: 703-249-9125
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: NICOLE SEAMAN
Title or Position: FOUNDER, OWNER
Credential:
Phone: 843-655-1978