Provider Demographics
NPI:1366008203
Name:SREWART, VIRGINIA ELIZABETH (MA/CCC-S)
Entity Type:Individual
Prefix:MRS
First Name:VIRGINIA
Middle Name:ELIZABETH
Last Name:SREWART
Suffix:
Gender:F
Credentials:MA/CCC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 ALAN B MOLLOHAN DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT ZION
Mailing Address - State:WV
Mailing Address - Zip Code:26151-8500
Mailing Address - Country:US
Mailing Address - Phone:304-354-7011
Mailing Address - Fax:
Practice Address - Street 1:540 ALAN B MOLLOHAN DR
Practice Address - Street 2:
Practice Address - City:MOUNT ZION
Practice Address - State:WV
Practice Address - Zip Code:26151-8500
Practice Address - Country:US
Practice Address - Phone:304-354-7011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-16
Last Update Date:2019-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1956235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist