Healthcare Provider Details

I. General information

NPI: 1851632814
Provider Name (Legal Business Name): RICHMOND SPEECH THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2013
Last Update Date: 03/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7519 MONTROSE AVE
RICHMOND VA
23227-1810
US

IV. Provider business mailing address

7519 MONTROSE AVE
RICHMOND VA
23227-1810
US

V. Phone/Fax

Practice location:
  • Phone: 804-519-2845
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number2202006163
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2202006163
License Number StateVA

VIII. Authorized Official

Name: HADIYA COPPEDGE
Title or Position: SPEECH LANGUAGE PATHOLOGIST
Credential: CCC-SLP
Phone: 804-519-2845