=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710310925
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NORMAN SPEECH SERVICES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/12/2013
-----------------------------------------------------
Last Update Date | 08/12/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1915 HUGUENOT ROAD
-----------------------------------------------------
City | RICHMOND
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23235
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-594-0323
-----------------------------------------------------
Fax | 804-594-0322
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1915 HUGUENOT ROAD
-----------------------------------------------------
City | RICHMOND
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23235
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 804-594-0323
-----------------------------------------------------
Fax | 804-594-0322
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. MICHELE L NORMAN
-----------------------------------------------------
Credential | PHD, CCC-SLP
-----------------------------------------------------
Telephone | 804-594-0323
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | 2202002997
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------