Healthcare Provider Details

I. General information

NPI: 1679659403
Provider Name (Legal Business Name): ROANOKE VALLEY SPEECH AND HEARING CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 04/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2030 COLONIAL AVE. SW
ROANOKE VA
24015-3204
US

IV. Provider business mailing address

2030 COLONIAL AVE. SW
ROANOKE VA
24015-3204
US

V. Phone/Fax

Practice location:
  • Phone: 540-343-0165
  • Fax: 540-345-4664
Mailing address:
  • Phone: 540-343-0165
  • Fax: 540-345-4664

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number2101001443
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number2201000601
License Number StateVA

VIII. Authorized Official

Name: MS. J ANDREE' BROOKS
Title or Position: PRESIDENT
Credential: PHR
Phone: 540-343-0165