Provider Demographics
NPI:1043267057
Name:HARRELL, RHONDA (MS)
Entity Type:Individual
Prefix:
First Name:RHONDA
Middle Name:
Last Name:HARRELL
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 609
Mailing Address - Street 2:
Mailing Address - City:CLIFTON FORGE
Mailing Address - State:VA
Mailing Address - Zip Code:24422-0609
Mailing Address - Country:US
Mailing Address - Phone:540-862-6688
Mailing Address - Fax:540-862-6749
Practice Address - Street 1:102 HIGHLAND AVE SE
Practice Address - Street 2:SUITE 104
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24013-2256
Practice Address - Country:US
Practice Address - Phone:540-343-4423
Practice Address - Fax:540-343-0495
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2101001334237700000X
VA2201001093231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010123283Medicaid
VA00W290D01Medicare PIN
VA010123283Medicaid