Basic Information
| Provider Information | |||||||||
| NPI: | 1396353488 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NEWSOME | ||||||||
| FirstName: | DEREK | ||||||||
| MiddleName: | G | ||||||||
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| Credential: | SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 435 STOCKTON ST | ||||||||
| Address2: | |||||||||
| City: | HAMPTON | ||||||||
| State: | VA | ||||||||
| PostalCode: | 236691350 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7572148203 | ||||||||
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| Practice Location | |||||||||
| Address1: | 100 ANNA GOODE WAY | ||||||||
| Address2: | |||||||||
| City: | SUFFOLK | ||||||||
| State: | VA | ||||||||
| PostalCode: | 234349236 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7579235500 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/15/2020 | ||||||||
| LastUpdateDate: | 07/15/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/15/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 2202009417 | VA | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.