Provider Demographics
NPI:1013263037
Name:WILLIAMSBURG SPEECH SPECIALTIES, LLC
Entity Type:Organization
Organization Name:WILLIAMSBURG SPEECH SPECIALTIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BEAVERS
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:757-345-3329
Mailing Address - Street 1:5928 MONTPELIER DR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188-8122
Mailing Address - Country:US
Mailing Address - Phone:757-345-3329
Mailing Address - Fax:757-565-1738
Practice Address - Street 1:1769 JAMESTOWN RD
Practice Address - Street 2:SUITE 103
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185-2324
Practice Address - Country:US
Practice Address - Phone:757-229-2516
Practice Address - Fax:757-565-1738
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-27
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202004986235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty