Basic Information
Provider Information
NPI: 1063620052
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SCHENKEIN
FirstName: TERRI
MiddleName: LC
NamePrefix:  
NameSuffix:  
Credential: PH.D
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 36007
Address2:  
City: NORTH CHESTERFIELD
State: VA
PostalCode: 232358000
CountryCode: US
TelephoneNumber: 8044843700
FaxNumber: 8043230770
Practice Location
Address1: 4700 PUDDLEDOCK RD STE 100
Address2:  
City: PRINCE GEORGE
State: VA
PostalCode: 238751268
CountryCode: US
TelephoneNumber: 8044843735
FaxNumber: 8043206462
Other Information
ProviderEnumerationDate: 05/21/2007
LastUpdateDate: 12/01/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 12/01/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
231H00000X2201001300VAY Speech, Language and Hearing Service ProvidersAudiologist 

No ID Information.


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