Provider Demographics
NPI:1457677502
Name:MALDON, KIAMESHA RACHAEL (MS CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:KIAMESHA
Middle Name:RACHAEL
Last Name:MALDON
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7114 SOTHEBY WAY
Mailing Address - Street 2:
Mailing Address - City:LORTON
Mailing Address - State:VA
Mailing Address - Zip Code:22079-4546
Mailing Address - Country:US
Mailing Address - Phone:571-251-3390
Mailing Address - Fax:
Practice Address - Street 1:7114 SOTHEBY WAY
Practice Address - Street 2:
Practice Address - City:LORTON
Practice Address - State:VA
Practice Address - Zip Code:22079-4546
Practice Address - Country:US
Practice Address - Phone:571-251-3390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-14
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202005679235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist