Provider Demographics
NPI:1497353890
Name:SPEECH AT THE BEACH, PLLC
Entity Type:Organization
Organization Name:SPEECH AT THE BEACH, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:CAUSEY
Authorized Official - Suffix:
Authorized Official - Credentials:MS ED-CCC-SLP
Authorized Official - Phone:757-647-9138
Mailing Address - Street 1:2413 KENSTOCK DR
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-3310
Mailing Address - Country:US
Mailing Address - Phone:757-647-9138
Mailing Address - Fax:
Practice Address - Street 1:2413 KENSTOCK DR
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-3310
Practice Address - Country:US
Practice Address - Phone:757-647-9138
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-16
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1780219105OtherSPEECH