Provider Demographics
NPI:1922105121
Name:PIEDMONT SPEECH THERAPY, INC
Entity Type:Organization
Organization Name:PIEDMONT SPEECH THERAPY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:S
Authorized Official - Last Name:SIMS
Authorized Official - Suffix:
Authorized Official - Credentials:MED,MSCCC-SLP
Authorized Official - Phone:434-525-2394
Mailing Address - Street 1:15421 FOREST RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:FOREST
Mailing Address - State:VA
Mailing Address - Zip Code:24551-2274
Mailing Address - Country:US
Mailing Address - Phone:434-525-2394
Mailing Address - Fax:434-525-2118
Practice Address - Street 1:15421 FOREST RD
Practice Address - Street 2:SUITE D
Practice Address - City:FOREST
Practice Address - State:VA
Practice Address - Zip Code:24551-2274
Practice Address - Country:US
Practice Address - Phone:434-525-2394
Practice Address - Fax:434-525-2118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA278286OtherANTHEM BCBS
VA496700Medicare ID - Type Unspecified