=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679659403
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ROANOKE VALLEY SPEECH AND HEARING CENTER, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/27/2006
-----------------------------------------------------
Last Update Date | 04/14/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2030 COLONIAL AVE. SW
-----------------------------------------------------
City | ROANOKE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24015-3204
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-343-0165
-----------------------------------------------------
Fax | 540-345-4664
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2030 COLONIAL AVE. SW
-----------------------------------------------------
City | ROANOKE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24015-3204
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-343-0165
-----------------------------------------------------
Fax | 540-345-4664
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MS. J ANDREE' BROOKS
-----------------------------------------------------
Credential | PHR
-----------------------------------------------------
Telephone | 540-343-0165
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 237600000X
-----------------------------------------------------
Taxonomy Name | Audiologist-Hearing Aid Fitter
-----------------------------------------------------
License Number | 2101001443
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 231H00000X
-----------------------------------------------------
Taxonomy Name | Audiologist
-----------------------------------------------------
License Number | 2201000601
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------