Provider Demographics
NPI:1790168524
Name:BEST, JIM JR (CCC-SLP)
Entity Type:Individual
Prefix:MR
First Name:JIM
Middle Name:
Last Name:BEST
Suffix:JR
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 1:1001 SHELOR RD SW
Mailing Address - Street 2:
Mailing Address - City:MEADOWS OF DAN
Mailing Address - State:VA
Mailing Address - Zip Code:24120-3784
Mailing Address - Country:US
Mailing Address - Phone:276-734-5544
Mailing Address - Fax:
Practice Address - Street 1:817 WOODLAND DR.
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:VA
Practice Address - Zip Code:24171
Practice Address - Country:US
Practice Address - Phone:276-734-5544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-29
Last Update Date:2015-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2002000509235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA2002000509OtherCOMMONWEALTH OF VIRGINIA DEPARTMENT OF HEALTH PROFESSIONS