1003105313 NPI number — NORTH STAR SPEECH AND LANGUAGE, LLC

Table of content: PATRICK KELLY SHANOVICH M.D. (NPI 1487854469)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003105313 NPI number — NORTH STAR SPEECH AND LANGUAGE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH STAR SPEECH AND LANGUAGE, LLC
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:
6
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:
1003105313
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/07/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4301 FOREMAN TRL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VIRGINIA BEACH
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23456-8015
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-447-3463
Provider Business Mailing Address Fax Number:
757-447-3462

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4301 FOREMAN TRL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VIRGINIA BEACH
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23456-8015
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-447-3463
Provider Business Practice Location Address Fax Number:
757-447-3462
Provider Enumeration Date:
04/07/2011

Additional Information

Authorized Official

Authorized Official Last Name:
LOVELESS
Authorized Official First Name:
LAURA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER, SPEECH-LANGUAGE PATHOLOGIST
Authorized Official Telephone Number:
757-447-3463

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  2202006220 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com