Provider Demographics
NPI:1851661367
Name:VINSON, LATEAKA SHERI (MA CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:LATEAKA
Middle Name:SHERI
Last Name:VINSON
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2250 OLD BRICK RD
Mailing Address - Street 2:SUITE 2229
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-5944
Mailing Address - Country:US
Mailing Address - Phone:516-902-6713
Mailing Address - Fax:
Practice Address - Street 1:2250 OLD BRICK RD
Practice Address - Street 2:SUITE 2229
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23060
Practice Address - Country:US
Practice Address - Phone:516-902-6713
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-01
Last Update Date:2018-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20843235Z00000X
VA2202006448235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist