Healthcare Provider Details

I. General information

NPI: 1346432978
Provider Name (Legal Business Name): KATHERINE KILLIAN WOODS-NEWMAN M.A. SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2007
Last Update Date: 08/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

775 DENT RD
ROANOKE VA
24019-4116
US

IV. Provider business mailing address

775 DENT RD
ROANOKE VA
24019-4116
US

V. Phone/Fax

Practice location:
  • Phone: 540-265-4281
  • Fax: 540-265-4287
Mailing address:
  • Phone: 540-265-4281
  • Fax: 540-265-4287

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2202005343
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: