Provider Demographics
NPI:1376543934
Name:LYNCHBURG SPEECH THERAPY, INC.
Entity Type:Organization
Organization Name:LYNCHBURG SPEECH THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DENICE
Authorized Official - Middle Name:D
Authorized Official - Last Name:CLAPP
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP, CERT
Authorized Official - Phone:434-845-6355
Mailing Address - Street 1:1049 CLAYMONT DR
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24502-4481
Mailing Address - Country:US
Mailing Address - Phone:434-845-6355
Mailing Address - Fax:434-845-5854
Practice Address - Street 1:1049 CLAYMONT DR
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24502-4481
Practice Address - Country:US
Practice Address - Phone:434-845-6355
Practice Address - Fax:434-845-5854
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202002035235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA54303OtherSOUTHERN HEALTH SERV. INC
VA280352OtherANTHEM BC/BS
VA54303OtherSOUTHERN HEALTH SERV. INC