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General NPI Number Information
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NPI Number | 1790278687
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Entity Type | Individual
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Provider Name | KRISTIN NICHELLE PEACE
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Gender | Female
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Dates
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Enumeration Date | 06/14/2018
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Last Update Date | 06/14/2018
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Provider Practice Location Address
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Address Line | 5200 FRANCISTOWN RD
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City | GLEN ALLEN
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State | VA
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Zip | 23060-2841
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Country | US
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Telephone | 804-527-4672
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Fax |
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Provider Business Mailing Address
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Address Line | 1821 BANDERA DR
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City | HENRICO
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State | VA
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Zip | 23228-1415
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Country | US
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Telephone | 804-986-8512
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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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