Provider Demographics
NPI:1255526711
Name:BEHRER, PHYLLIS AVOLIO (MHS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:AVOLIO
Last Name:BEHRER
Suffix:
Gender:F
Credentials:MHS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 LEROY BOWEN DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24502-5093
Mailing Address - Country:US
Mailing Address - Phone:434-239-6630
Mailing Address - Fax:434-239-6640
Practice Address - Street 1:101 LEROY BOWEN DR
Practice Address - Street 2:SUITE A
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24502-5093
Practice Address - Country:US
Practice Address - Phone:434-239-6630
Practice Address - Fax:434-239-6640
Is Sole Proprietor?:No
Enumeration Date:2007-09-07
Last Update Date:2009-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202003981235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist