Individual
DRU A FILTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
SPEECH
Contact information
Practice address
5301 PROVIDENCE RD STE 90, VIRGINIA BEACH, VA 23464-4128
(757) 497-1900
Mailing address
255 ENTERPRISE BLVD STE 250, GREENVILLE, SC 29615-3575
(864) 454-0888
(864) 454-1130
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
033612
NY
235Z00000X
Speech-Language Pathologist
Primary
2202002892
VA
235Z00000X
Speech-Language Pathologist
2951
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
SA0330
—
SC
Enumeration date
07/22/2006
Last updated
04/20/2026
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