Provider Demographics
NPI:1730795865
Name:POLLOCK, KEMI DORIS-DESTINIE (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:KEMI
Middle Name:DORIS-DESTINIE
Last Name:POLLOCK
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 CROMWELL CT
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22554-8810
Mailing Address - Country:US
Mailing Address - Phone:540-422-9066
Mailing Address - Fax:
Practice Address - Street 1:9 CROMWELL CT
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554-8810
Practice Address - Country:US
Practice Address - Phone:540-422-9066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-23
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD02149L235Z00000X
VA2202010087235Z00000X
NY031871235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist