Katherine Jefferson, CCC-SLP

Individual provider Active NPI Speech-Language Pathologist · Stafford, VA

NPI 1265729503 · NPPES record last updated Jul 7, 2011

Key facts

NPI
1265729503
Entity type
Individual (NPI type 1)
Primary specialty
Speech-Language Pathologist 235Z00000X
License
22026210 (VA)
Practice address
2765 Jefferson Davis Hwy
Suite 209
Stafford, VA 22554-8331
Phone
(540) 720-2261
Fax
(540) 720-5660
NPI assigned
Jul 7, 2011
Sex
Female
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
22026210VAMDSpeech-Language Pathologist

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X 22026210 VA Yes

Addresses

Primary practice location

2765 Jefferson Davis Hwy
Suite 209
Stafford, VA 22554-8331

Mailing address

13890 Braddock Rd
Suite 205
Centreville, VA 20121-2435
Phone (540) 720-2261

Other providers in Stafford, VA

All providers in Stafford, VA · Speech-Language Pathologist in Virginia

Sources for this page

Verify at the official NPI Registry.