Provider Demographics
NPI:1326600347
Name:JAVIER, TIA (MA MS , CCC-SLP)
Entity Type:Individual
Prefix:
First Name:TIA
Middle Name:
Last Name:JAVIER
Suffix:
Gender:F
Credentials:MA MS , CCC-SLP
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Other - Last Name:
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Mailing Address - Street 1:6740 FOREST HILL AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23225-1847
Mailing Address - Country:US
Mailing Address - Phone:804-505-0251
Mailing Address - Fax:804-800-4251
Practice Address - Street 1:6740 FOREST HILL AVE STE 101
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23225-1847
Practice Address - Country:US
Practice Address - Phone:804-505-0251
Practice Address - Fax:804-800-4251
Is Sole Proprietor?:No
Enumeration Date:2019-06-29
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
225100000X, 225X00000X
VA2204000336235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1982657433Medicaid