Healthcare Provider Details

I. General information

NPI: 1982202040
Provider Name (Legal Business Name): NORTHERN NECK REGIONAL SPECIAL EDUCATION PROGRAM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2020
Last Update Date: 10/12/2020
Certification Date: 10/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6914 RICHMOND RD
WARSAW VA
22572-3547
US

IV. Provider business mailing address

PO BOX 1507
WARSAW VA
22572-1507
US

V. Phone/Fax

Practice location:
  • Phone: 804-333-6557
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code246Q00000X
TaxonomyPathology Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name: VIOLA THOMPSON
Title or Position: SPEECH LANGUAGE PATHOLOGIST
Credential: M.S. CF-SLP
Phone: 804-761-0276