Provider Demographics
NPI:1578544680
Name:DANVILLE SPEECH & HEARING CENTER
Entity Type:Organization
Organization Name:DANVILLE SPEECH & HEARING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXEC DIRECTOR/SPEECH/LANGUAGE PATH
Authorized Official - Prefix:MISS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:T
Authorized Official - Last Name:MARSHALL
Authorized Official - Suffix:
Authorized Official - Credentials:MA/CCC-SLP
Authorized Official - Phone:434-793-8255
Mailing Address - Street 1:742 WILSON ST
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24541-1910
Mailing Address - Country:US
Mailing Address - Phone:434-793-8255
Mailing Address - Fax:434-793-6017
Practice Address - Street 1:742 WILSON ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24541-1910
Practice Address - Country:US
Practice Address - Phone:434-793-8255
Practice Address - Fax:434-793-6017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA46140OtherOPTIMA - #
VA4978595Medicaid
VA4978595Medicaid