Healthcare Provider Details

I. General information

NPI: 1740901933
Provider Name (Legal Business Name): BRIDGET A CHARLTON MA, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2022
Last Update Date: 01/18/2024
Certification Date: 01/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 FORDHAM DR
VIRGINIA BEACH VA
23464-5368
US

IV. Provider business mailing address

826 W PRINCESS ANNE RD APT A5
NORFOLK VA
23517-1859
US

V. Phone/Fax

Practice location:
  • Phone: 757-361-3954
  • Fax:
Mailing address:
  • Phone: 973-590-6627
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2202011122
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: