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General NPI Number Information
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NPI Number | 1790255149
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Entity Type | Individual
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Provider Name | MARY JUDITH WEAVER M.S. ED.
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Gender | Female
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Dates
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Enumeration Date | 11/28/2018
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Last Update Date | 11/28/2018
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Provider Practice Location Address
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Address Line | 1716 GREY FRIARS CHASE
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City | VIRGINIA BEACH
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State | VA
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Zip | 23456-5435
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Country | US
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Telephone | 757-648-3640
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Fax |
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Provider Business Mailing Address
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Address Line | 3829 LASALLE DR APT 105
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City | VIRGINIA BEACH
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State | VA
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Zip | 23453-4755
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Country | US
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Telephone | 814-657-5151
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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