Provider Demographics
NPI:1558196121
Name:HEDGEPETH, CHADWICK YANASA JR (MED, CF-SLP)
Entity type:Individual
Prefix:MR
First Name:CHADWICK
Middle Name:YANASA
Last Name:HEDGEPETH
Suffix:JR
Gender:M
Credentials:MED, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:538 WINDERMERE DR
Mailing Address - Street 2:
Mailing Address - City:CULPEPER
Mailing Address - State:VA
Mailing Address - Zip Code:22701-2056
Mailing Address - Country:US
Mailing Address - Phone:540-905-9087
Mailing Address - Fax:
Practice Address - Street 1:14300 ACHIEVEMENT DR
Practice Address - Street 2:
Practice Address - City:CULPEPER
Practice Address - State:VA
Practice Address - Zip Code:22701-1648
Practice Address - Country:US
Practice Address - Phone:540-825-4140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-04
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2204001368235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist