Provider Demographics
NPI:1649828609
Name:PERRYMAN, AVERY (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:AVERY
Middle Name:
Last Name:PERRYMAN
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 S 1ST ST APT 412
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23219-3760
Mailing Address - Country:US
Mailing Address - Phone:303-323-5773
Mailing Address - Fax:
Practice Address - Street 1:2100 BRANDERMILL PKWY
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23112-4160
Practice Address - Country:US
Practice Address - Phone:804-621-7328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-03
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist