Organization Name: | TIDEWATER SPEECH AND LANGUAGE SERVICES |
NPI Number: | 1073989240 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | PAMELA CRENSHAW (OWNER/DIRECTOR) |
Mailing Address: | 110 Kingsley Ln Suite 209 Norfolk |
State: | VA US |
Postal Code: | 235054614 |
Phone Number: | 7574231933 |
Fax Number: | |
NPI Enumeration Date: | 08/11/2015 |
NPI Last Update Date: | 08/11/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 2202006671 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | VA |
Taxonomy Type: | Speech, Language and Hearing Service Providers |
Taxonomy Classification: | Speech-Language Pathologist |
Taxonomy Specialization: | |
Taxonomy Definition: | A speech pathologist is a person qualified by a master |