Provider Demographics
NPI:1477742708
Name:WEST VIRGINIA UNIVERSITY
Entity Type:Organization
Organization Name:WEST VIRGINIA UNIVERSITY
Other - Org Name:WVU SPEECH AND HEARING CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATIVE ASSOCIATE
Authorized Official - Prefix:MS
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:A
Authorized Official - Last Name:RIDGWAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-293-2724
Mailing Address - Street 1:355 OAKLAND ST.
Mailing Address - Street 2:805 ALLEN HALL, PO BOX 6122
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26506-6122
Mailing Address - Country:US
Mailing Address - Phone:304-293-4241
Mailing Address - Fax:
Practice Address - Street 1:355 OAKLAND ST.
Practice Address - Street 2:805 ALLEN HALL
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26506-6122
Practice Address - Country:US
Practice Address - Phone:304-293-4241
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-23
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV231H00000X, 235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0160342000Medicaid