Provider Demographics
NPI:1376099028
Name:JEFFERSON, KIRI (MA CF-SLP)
Entity Type:Individual
Prefix:
First Name:KIRI
Middle Name:
Last Name:JEFFERSON
Suffix:
Gender:F
Credentials:MA CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1102 ROSE HILL DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22903-5128
Mailing Address - Country:US
Mailing Address - Phone:434-979-8628
Mailing Address - Fax:
Practice Address - Street 1:200 WEST 12TH ST
Practice Address - Street 2:A1-100
Practice Address - City:WAYNESBORO
Practice Address - State:VA
Practice Address - Zip Code:22980-4771
Practice Address - Country:US
Practice Address - Phone:540-941-5501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-31
Last Update Date:2017-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202008281235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist