Provider Demographics
NPI:1114067626
Name:SINGLETARY-FULLER, KAREN (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:SINGLETARY-FULLER
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 1:4211 RIDGE TOP RD APT 3626
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-1111
Mailing Address - Country:US
Mailing Address - Phone:703-298-3421
Mailing Address - Fax:
Practice Address - Street 1:4211 RIDGE TOP RD APT 3626
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-1111
Practice Address - Country:US
Practice Address - Phone:703-298-3421
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7112235Z00000X
SC2293235Z00000X
VA2202003160235Z00000X
GASLP007149235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7412535Medicaid