1225260839 NPI number — BETTER SPEECH: DIAGNOSTIC & THERAPY SERVICES, PLLC

Table of content: (NPI 1225260839)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225260839 NPI number — BETTER SPEECH: DIAGNOSTIC & THERAPY SERVICES, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BETTER SPEECH: DIAGNOSTIC & THERAPY SERVICES, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1225260839
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/28/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9563 15TH BAY ST
Provider Second Line Business Mailing Address:
APT 3
Provider Business Mailing Address City Name:
NORFOLK
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23518-6242
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-749-1638
Provider Business Mailing Address Fax Number:
757-340-4607

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9563 15TH BAY ST APT 3
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORFOLK
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23518-6212
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-749-1638
Provider Business Practice Location Address Fax Number:
757-340-4607
Provider Enumeration Date:
08/14/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WILSON
Authorized Official First Name:
MARCY
Authorized Official Middle Name:
J
Authorized Official Title or Position:
SPEECH LANGUAGE PATHOLOGIST
Authorized Official Telephone Number:
757-749-1638

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: Q46175D404 . This is a "MEDICARE PTAN" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".