Provider Demographics
NPI:1770637555
Name:LONGWOOD UNIVERSITY
Entity Type:Organization
Organization Name:LONGWOOD UNIVERSITY
Other - Org Name:LONGWOOD SPEECH, HEARING AND LEARNING SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR, SHLS
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:POWER-DEFUR
Authorized Official - Suffix:
Authorized Official - Credentials:PHD CCC-SLP
Authorized Official - Phone:434-395-2972
Mailing Address - Street 1:PO BOX 513
Mailing Address - Street 2:315 WEST THIRD STREET
Mailing Address - City:FARMVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23901-0513
Mailing Address - Country:US
Mailing Address - Phone:434-395-2972
Mailing Address - Fax:434-395-2622
Practice Address - Street 1:315 W 3RD ST
Practice Address - Street 2:
Practice Address - City:FARMVILLE
Practice Address - State:VA
Practice Address - Zip Code:23901-1201
Practice Address - Country:US
Practice Address - Phone:434-395-2972
Practice Address - Fax:434-395-2622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2015-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
231H00000X, 231HA2400X, 231HA2500X, 235500000X, 235Z00000X, 237600000X, 237700000X
VA2101001501332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
No231HA2400XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology PractitionerGroup - Multi-Specialty
No231HA2500XSpeech, Language and Hearing Service ProvidersAudiologistAssistive Technology SupplierGroup - Multi-Specialty
No235500000XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistGroup - Multi-Specialty
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Multi-Specialty
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Multi-Specialty
No332S00000XSuppliersHearing Aid EquipmentGroup - Multi-Specialty