Provider Demographics
NPI:1679714596
Name:SYMONDS, KIA H
Entity Type:Individual
Prefix:
First Name:KIA
Middle Name:H
Last Name:SYMONDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4009 FITZHUGH AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-3953
Mailing Address - Country:US
Mailing Address - Phone:804-447-5240
Mailing Address - Fax:804-447-5241
Practice Address - Street 1:4009 FITZHUGH AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-3953
Practice Address - Country:US
Practice Address - Phone:804-447-5240
Practice Address - Fax:804-447-5241
Is Sole Proprietor?:No
Enumeration Date:2009-03-24
Last Update Date:2009-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202003302225X00000X, 235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1679714596Medicaid
VA1679714596Medicaid