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General NPI Number Information
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NPI Number | 1912455023
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Entity Type | Organization
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Legal Business Name | KIERNAN SPEECH THERAPY LLC
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Dates
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Enumeration Date | 09/18/2016
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Last Update Date | 11/18/2022
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Provider Practice Location Address
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Address Line | 1100 VOLVO PKWY STE 320
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City | CHESAPEAKE
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State | VA
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Zip | 23320-3341
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Country | US
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Telephone | 757-606-0531
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Fax | 866-288-0815
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Provider Business Mailing Address
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Address Line | 1100 VOLVO PKWY STE 320
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City | CHESAPEAKE
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State | VA
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Zip | 23320-3341
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Country | US
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Telephone | 757-606-0531
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Fax | 866-288-0815
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Authorized Official
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Title or Position | OWNER
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Name | ALYSSA KIERNAN
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Credential | M.S. CCC-SLP, CBIS
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Telephone | 757-606-0531
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QH0700X
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Taxonomy Name | Hearing and Speech Clinic/Center
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License Number | 2202007680
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License Number State | VA
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