Provider Demographics
NPI:1588956189
Name:BANKS, CLUVERIUS (CCC/SLP)
Entity type:Individual
Prefix:MRS
First Name:CLUVERIUS
Middle Name:
Last Name:BANKS
Suffix:
Gender:F
Credentials:CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 LOCKSLEY DR
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-5006
Mailing Address - Country:US
Mailing Address - Phone:757-869-7559
Mailing Address - Fax:757-827-0442
Practice Address - Street 1:36 LOCKSLEY DR
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-5006
Practice Address - Country:US
Practice Address - Phone:757-869-7559
Practice Address - Fax:757-827-0442
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-14
Last Update Date:2011-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202002934235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist