MEDICARE: KASTEN ELIZABETH BRAFFORD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	2202007959	VA

General Provider Information

NPI Number	:	1083090237
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KASTEN ELIZABETH BRAFFORD

Provider Business Mailing Address
First Line	:	PO BOX 6204
Second Line	:
City	:	NEWPORT NEWS
State	:	VA
Zip	:	23606-0204
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3800 POPLAR HILL RD STE B
Second Line	:
City	:	CHESAPEAKE
State	:	VA
Zip	:	23321-5522
Country	:	US
Telephone Number	:	757-776-3088
Fax Number	:	757-612-4499

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/10/2015
Last Update Date	:	12/13/2022

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Directions to “ KASTEN ELIZABETH BRAFFORD ” Practice Location

Language	Start Address	Practice Location

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