Individual
KIMBERLY LAVACCA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, CCC-SLP
Contact information
Practice address
680 KINGSBOROUGH SQ STE B, CHESAPEAKE, VA 23320-4988
(757) 547-0434
(575) 470-6257
Mailing address
1377 MOTOR PKWY STE 307, ISLANDIA, NY 11749-5258
(914) 265-4582
(631) 760-8306
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
2202010342
VA
235Z00000X
Speech-Language Pathologist
2204000647
VA
Other
Enumeration date
04/21/2021
Last updated
03/07/2022
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