Kimberly Lavacca, MS, CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

2202010342 Issued in VA

Practice address

680 Kingsborough SQ Ste B
Chesapeake, VA 23320-4988

Phone

(757) 547-0434

Fax

(575) 470-6257

NPI assigned

Apr 21, 2021

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in VA

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Ivyrehab Sept, LLC

  • Physical Therapist
  • Virginia Beach, VA
  • NPI 1982657433

  Speech-Language Pathologist

  Medicare reassignment NPD
• Ivyrehab Sept, LLC

  • Physical Medicine & Rehabilitation Physician
  • Verona, VA
  • NPI 1235955709
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1618963200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1646611200000",
    "number": "1396327219",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1377 MOTOR PKWY STE 307",
            "city": "ISLANDIA",
            "state": "NY",
            "postal_code": "117495258",
            "telephone_number": "914-265-4582",
            "fax_number": "631-760-8306"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "680 KINGSBOROUGH SQ STE B",
            "city": "CHESAPEAKE",
            "state": "VA",
            "postal_code": "233204988",
            "telephone_number": "757-547-0434",
            "fax_number": "575-470-6257"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAVACCA",
        "first_name": "KIMBERLY",
        "credential": "MS, CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-04-21",
        "last_updated": "2022-03-07",
        "certification_date": "2022-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "VA",
            "license": "2204000647",
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "VA",
            "license": "2202010342",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Chelsea Morgan Lavoun
• Bertha Osaigbokan Lawani, NP-C
• Lawrence Hyde Corporation (Lawrence Pharmacy)
• Lawrence Hyde Corporation (Lawrence Pharmacy)
• Lawrence Pharmacy

• Speech-Language Pathologist in Chesapeake, VA
• Providers in Chesapeake, VA by specialty
• Speech-Language Pathologist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.