Provider Demographics
NPI:1477392074
Name:EXECUTIVE SPEECH INNOVATIONS, LLC
Entity type:Organization
Organization Name:EXECUTIVE SPEECH INNOVATIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:804-286-0080
Mailing Address - Street 1:1802 TYNDALL POINT RD
Mailing Address - Street 2:
Mailing Address - City:GLOUCESTER POINT
Mailing Address - State:VA
Mailing Address - Zip Code:23062-2316
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1802 TYNDALL POINT RD
Practice Address - Street 2:
Practice Address - City:GLOUCESTER POINT
Practice Address - State:VA
Practice Address - Zip Code:23062-2316
Practice Address - Country:US
Practice Address - Phone:804-286-0080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-22
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty