Provider Demographics
NPI:1649529116
Name:FERGUSON, KATHLEEN (SLP)
Entity type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11440 NORWEGIAN MILL CT.
Mailing Address - Street 2:
Mailing Address - City:OAKTON
Mailing Address - State:VA
Mailing Address - Zip Code:22124
Mailing Address - Country:US
Mailing Address - Phone:703-628-8580
Mailing Address - Fax:
Practice Address - Street 1:11240 WAPLES MILL ROAD
Practice Address - Street 2:SUITE 202
Practice Address - City:OAKTON
Practice Address - State:VA
Practice Address - Zip Code:22124
Practice Address - Country:US
Practice Address - Phone:703-237-2219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-30
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202000887235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist