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General NPI Number Information
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NPI Number | 1326349747
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Entity Type | Organization
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Legal Business Name | SPEECH AND LANGUAGE SERVICES OF VIRGINIA
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Dates
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Enumeration Date | 11/17/2010
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Last Update Date | 11/17/2010
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Provider Practice Location Address
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Address Line | 12388 WARWICK BLVD SUITE 310
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City | NEWPORT NEWS
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State | VA
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Zip | 23606-3850
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Country | US
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Telephone | 757-262-8644
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Fax |
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Provider Business Mailing Address
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Address Line | 12388 WARWICK BLVD SUITE 310
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City | NEWPORT NEWS
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State | VA
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Zip | 23606-3850
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | SPEECH LANGUAGE PATHOLOGIST
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Name | NICOLE PAQUETTE
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Credential | M.A. CCC-SLP
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Telephone | 757-262-8644
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0700X
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Taxonomy Name | Hearing and Speech Clinic/Center
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License Number | 2202005881
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License Number State | VA
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