Active NPI
Renee Lea Desjarlais, M.S., CCC-SLP
- Speech-Language Pathologist
- Virginia Beach, VA
National Provider Identifier
1619419801
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 2202004519
- Practice address
- 4560 South Blvd
Virginia Beach, VA 23452-1160 - Phone
- (757) 228-5635
- Fax
- (757) 233-0327
- NPI assigned
- Nov 5, 2016
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 2202004519 | VA | Primary |
Addresses
Primary practice location
4560 South Blvd
Virginia Beach, VA 23452-1160
Mailing address
629 Ridge Cir
Chesapeake, VA 23320-4858
Phone (757) 646-0503
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2202004519 | VA | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1478304000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1478304000000",
"number": "1619419801",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "629 RIDGE CIR",
"city": "CHESAPEAKE",
"state": "VA",
"postal_code": "233204858",
"telephone_number": "757-646-0503"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4560 SOUTH BLVD",
"city": "VIRGINIA BEACH",
"state": "VA",
"postal_code": "234521160",
"telephone_number": "757-228-5635",
"fax_number": "757-233-0327"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DESJARLAIS",
"first_name": "RENEE",
"middle_name": "LEA",
"credential": "M.S., CCC-SLP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-11-05",
"last_updated": "2016-11-05",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "VA",
"license": "2202004519",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Virginia Beach, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.