Provider Demographics
NPI:1689758427
Name:INTEGRATIVE COMMUNICATION HEALTH SERVICES, INC
Entity Type:Organization
Organization Name:INTEGRATIVE COMMUNICATION HEALTH SERVICES, INC
Other - Org Name:WOLFE SPEECH THERAPY PLUS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SUZETTE
Authorized Official - Middle Name:D
Authorized Official - Last Name:WOLFE
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP CERT-AV
Authorized Official - Phone:540-885-7774
Mailing Address - Street 1:1105 GREENVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:STAUNTON
Mailing Address - State:VA
Mailing Address - Zip Code:24401-5010
Mailing Address - Country:US
Mailing Address - Phone:540-885-7774
Mailing Address - Fax:540-885-7776
Practice Address - Street 1:1105 GREENVILLE AVE
Practice Address - Street 2:
Practice Address - City:STAUNTON
Practice Address - State:VA
Practice Address - Zip Code:24401-5010
Practice Address - Country:US
Practice Address - Phone:540-885-7774
Practice Address - Fax:540-885-7776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2355S0801X
VA2202002395235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010238293Medicaid
VA009113002Medicaid
VA000209082Medicaid
VA004943619Medicaid
VA004943619Medicaid