Provider Demographics
NPI:1083638092
Name:KENT, ALICIA ANTOINETTE (MS, ED CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:ALICIA
Middle Name:ANTOINETTE
Last Name:KENT
Suffix:
Gender:F
Credentials:MS, ED CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1348 GOOSE LNDG
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23451-6520
Mailing Address - Country:US
Mailing Address - Phone:757-422-2357
Mailing Address - Fax:
Practice Address - Street 1:2135 GENERAL BOOTH BLVD
Practice Address - Street 2:SUITE 152
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-5881
Practice Address - Country:US
Practice Address - Phone:757-430-8828
Practice Address - Fax:757-430-8189
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202004492235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA4980701Medicaid
VA4980701Medicaid