=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255114302
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COLLABORATIVE SPEECH SOLUTIONS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/14/2023
-----------------------------------------------------
Last Update Date | 08/14/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 33 CEDAR RD
-----------------------------------------------------
City | POQUOSON
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23662-2107
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-374-6772
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 33 CEDAR RD
-----------------------------------------------------
City | POQUOSON
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23662-2107
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-374-6772
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SPEECH-LANGUAGE PATHOLOGIST
-----------------------------------------------------
Name | MRS. HEATHER LINNAE PATTON
-----------------------------------------------------
Credential | MS, CCC-SLP
-----------------------------------------------------
Telephone | 804-815-9417
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA3000X
-----------------------------------------------------
Taxonomy Name | Augmentative Communication Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QH0700X
-----------------------------------------------------
Taxonomy Name | Hearing and Speech Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------