Individual
MRS. KIMMY SHIN ELLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, CCC-SLP
Contact information
Practice address
601 CHILDRENS LN, NORFOLK, VA 23507-1910
(757) 668-6589
Mailing address
1100 LORD DUNMORE DR, VIRGINIA BEACH, VA 23464-5446
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
2202004900
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12051459
ASHA CERTIFIED MEMBER
VA
Enumeration date
05/15/2007
Last updated
07/08/2007
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