Provider Demographics
NPI:1205443363
Name:HERDEWE EDUCATIONAL AUDIOLOGY AND SPEECH LANGUAGE SERVICES, LLC
Entity type:Organization
Organization Name:HERDEWE EDUCATIONAL AUDIOLOGY AND SPEECH LANGUAGE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/AUDIOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:L
Authorized Official - Last Name:PILLOW
Authorized Official - Suffix:
Authorized Official - Credentials:AUD,EDD
Authorized Official - Phone:540-968-0100
Mailing Address - Street 1:283 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:24426-1542
Mailing Address - Country:US
Mailing Address - Phone:540-968-0100
Mailing Address - Fax:
Practice Address - Street 1:283 W MAIN ST
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:VA
Practice Address - Zip Code:24426-1542
Practice Address - Country:US
Practice Address - Phone:540-968-0100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-23
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid FitterGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty