Provider Demographics
NPI:1295875797
Name:ATLANTIC SPEECH THERAPY LLC
Entity type:Organization
Organization Name:ATLANTIC SPEECH THERAPY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:R
Authorized Official - Last Name:OSISEK
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:757-422-6342
Mailing Address - Street 1:923 FIRST COLONIAL RD
Mailing Address - Street 2:SUITE 1811
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-3182
Mailing Address - Country:US
Mailing Address - Phone:757-422-6342
Mailing Address - Fax:757-422-6343
Practice Address - Street 1:923 FIRST COLONIAL RD
Practice Address - Street 2:SUITE 1811
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-3182
Practice Address - Country:US
Practice Address - Phone:757-422-6342
Practice Address - Fax:757-422-6343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202003836235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA195598OtherANTHEM BLUE CROSS BLUE SH
VA32105OtherOPTIMA SENTARA