Healthcare Provider Details

I. General information

NPI: 1518143155
Provider Name (Legal Business Name): DINA RIVKA HOROWITZ SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2008
Last Update Date: 01/14/2008
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

1224 PRINCE EDWARD WAY
NORFOLK VA
23517-2259
US

V. Phone/Fax

Practice location:
  • Phone: 757-361-3954
  • Fax:
Mailing address:
  • Phone: 757-627-5928
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2202005197
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: