Provider Demographics
NPI:1225260839
Name:BETTER SPEECH: DIAGNOSTIC & THERAPY SERVICES, PLLC
Entity Type:Organization
Organization Name:BETTER SPEECH: DIAGNOSTIC & THERAPY SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:MARCY
Authorized Official - Middle Name:J
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:757-749-1638
Mailing Address - Street 1:9563 15TH BAY ST
Mailing Address - Street 2:APT 3
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23518-6242
Mailing Address - Country:US
Mailing Address - Phone:757-749-1638
Mailing Address - Fax:757-340-4607
Practice Address - Street 1:9563 15TH BAY ST APT 3
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23518-6212
Practice Address - Country:US
Practice Address - Phone:757-749-1638
Practice Address - Fax:757-340-4607
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-14
Last Update Date:2016-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAQ46175D404OtherMEDICARE PTAN