Provider Demographics
NPI:1720389240
Name:DOUGHERTY, JOHN JAMES (CCC-SLP)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:JAMES
Last Name:DOUGHERTY
Suffix:
Gender:M
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 N NINTH ST FL 13
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23219-1927
Mailing Address - Country:US
Mailing Address - Phone:804-780-7312
Mailing Address - Fax:
Practice Address - Street 1:EXCEPTIONAL EDUCATION & STUDENT SERVICES, 13TH FLOOR
Practice Address - Street 2:301 NORTH NINTH STREET
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23219-1927
Practice Address - Country:US
Practice Address - Phone:804-780-7312
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-15
Last Update Date:2018-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202005980235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist