Provider Demographics
NPI:1912455023
Name:KIERNAN SPEECH THERAPY LLC
Entity Type:Organization
Organization Name:KIERNAN SPEECH THERAPY LLC
Other - Org Name:SHORE THERAPY GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALYSSA
Authorized Official - Middle Name:
Authorized Official - Last Name:KIERNAN
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP, CBIS
Authorized Official - Phone:757-606-0531
Mailing Address - Street 1:1100 VOLVO PKWY STE 320
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-3341
Mailing Address - Country:US
Mailing Address - Phone:757-606-0531
Mailing Address - Fax:866-288-0815
Practice Address - Street 1:1100 VOLVO PKWY STE 320
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-3341
Practice Address - Country:US
Practice Address - Phone:757-606-0531
Practice Address - Fax:866-288-0815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-18
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
208100000X
VA2202007680261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty