Healthcare Provider Details

I. General information

NPI: 1023032828
Provider Name (Legal Business Name): MARY RENEE BIEGUN SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY RENEE BIEGUN SLP

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 FORDHAM DR
VIRGINIA BEACH VA
23464-5368
US

IV. Provider business mailing address

718 GLADESDALE DR
CHESAPEAKE VA
23322-7751
US

V. Phone/Fax

Practice location:
  • Phone: 757-361-3954
  • Fax:
Mailing address:
  • Phone: 757-482-9947
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2202002753
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: