Provider Demographics
NPI:1811988348
Name:NELSON, VIRGINIA ANNE (MS SLP)
Entity type:Individual
Prefix:MS
First Name:VIRGINIA
Middle Name:ANNE
Last Name:NELSON
Suffix:
Gender:F
Credentials:MS SLP
Other - Prefix:MISS
Other - First Name:VIRGINIA
Other - Middle Name:ANNE
Other - Last Name:MOSELY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA SLP
Mailing Address - Street 1:6910 PANORAMA DR
Mailing Address - Street 2:
Mailing Address - City:PANORA
Mailing Address - State:IA
Mailing Address - Zip Code:50216-8753
Mailing Address - Country:US
Mailing Address - Phone:641-757-2830
Mailing Address - Fax:
Practice Address - Street 1:2400 POPLAR AVE
Practice Address - Street 2:
Practice Address - City:GUTHRIE CENTER
Practice Address - State:IA
Practice Address - Zip Code:50115-8878
Practice Address - Country:US
Practice Address - Phone:641-757-2830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01624235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist