Provider Demographics
NPI:1184927485
Name:SPEECH LANGUAGE INTERVENTION STRATEGIES SPEECHLIS
Entity type:Organization
Organization Name:SPEECH LANGUAGE INTERVENTION STRATEGIES SPEECHLIS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MARISA
Authorized Official - Middle Name:
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP
Authorized Official - Phone:757-603-6303
Mailing Address - Street 1:161 JOHN JEFFERSON RD # A
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23185-5640
Mailing Address - Country:US
Mailing Address - Phone:757-603-6303
Mailing Address - Fax:
Practice Address - Street 1:161 JOHN JEFFERSON RD # A
Practice Address - Street 2:SUITE 1
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185-5640
Practice Address - Country:US
Practice Address - Phone:757-603-6303
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-08
Last Update Date:2011-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202005417261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1861627366Medicaid