Provider Demographics
NPI:1669706776
Name:HEREK, KASHA MUSTIN (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:KASHA
Middle Name:MUSTIN
Last Name:HEREK
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4715 HELENSBURGH DR APT 201
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23321-5033
Mailing Address - Country:US
Mailing Address - Phone:757-304-6282
Mailing Address - Fax:
Practice Address - Street 1:4715 HELENSBURGH DR APT 201
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23321-5033
Practice Address - Country:US
Practice Address - Phone:757-304-6282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-22
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202005868235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA004979061Medicaid
VA496668Medicare Oscar/Certification