NPIMap

Organization Active NPI

Kiernan Speech Therapy LLC

Doing business as Shore Therapy Group

  • Hearing and Speech Clinic/Center
  • Chesapeake, VA
National Provider Identifier
1912455023
Registry record updated Nov 18, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hearing and Speech Clinic/CenterTaxonomy code 261QH0700X
License
2202007680 Issued in VA
Legal business name
KIERNAN SPEECH THERAPY LLC
Doing business as
Shore Therapy Group
Tidewater Swallowing Diagnostics
Practice address
1100 Volvo Pkwy Ste 320
Chesapeake, VA 23320-3341
Phone
(757) 606-0531
Fax
(866) 288-0815
NPI assigned
Sep 18, 2016
Last updated
Nov 18, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 18, 2022

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

Authorized official

Name
Alyssa Kiernan, M.S. CCC-SLP, CBISNPI 1528454477
Title
Owner
Phone
(757) 606-0531

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Medicine & Rehabilitation Physician 208100000X NU
Hearing and Speech Clinic/Center 261QH0700X 2202007680 VA Primary

Addresses

Primary practice location

1100 Volvo Pkwy Ste 320
Chesapeake, VA 23320-3341

Mailing address

1100 Volvo Pkwy Ste 320
Chesapeake, VA 23320-3341
Phone (757) 606-0531

Other names 2

  • Shore Therapy Group Doing business as
  • Tidewater Swallowing Diagnostics Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20161129000000 VA Part B Supplier - Clinic/Group Practice 4183903677 Receives reassigned benefits from 4 practitioners
Practice locations: Chesapeake, VA

National Provider Directory

National Provider Directory

Locations

1100 Volvo Pkwy
Ste 320
Chesapeake, VA 23320
Phone (757) 606-0531

2147 Old Greenbrier Rd
Ste B
Chesapeake, VA 23320
Phone (757) 361-5824

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1474156800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1668729600000",
    "number": "1912455023",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1100 VOLVO PKWY STE 320",
            "city": "CHESAPEAKE",
            "state": "VA",
            "postal_code": "233203341",
            "telephone_number": "757-606-0531",
            "fax_number": "866-288-0815"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 VOLVO PKWY STE 320",
            "city": "CHESAPEAKE",
            "state": "VA",
            "postal_code": "233203341",
            "telephone_number": "757-606-0531",
            "fax_number": "866-288-0815"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIERNAN SPEECH THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-09-18",
        "last_updated": "2022-11-18",
        "certification_date": "2022-11-18",
        "status": "A",
        "authorized_official_last_name": "KIERNAN",
        "authorized_official_first_name": "ALYSSA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "757-606-0531",
        "authorized_official_credential": "M.S. CCC-SLP, CBIS"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QH0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Hearing and Speech",
            "state": "VA",
            "license": "2202007680",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Shore Therapy Group",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Tidewater Swallowing Diagnostics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Chesapeake, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 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.