Provider Demographics
NPI:1750682787
Name:FITZGERALD, WINIFRED MARIE (MS, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:WINIFRED
Middle Name:MARIE
Last Name:FITZGERALD
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 OAK AVE
Mailing Address - Street 2:
Mailing Address - City:WAYNESBORO
Mailing Address - State:VA
Mailing Address - Zip Code:22980-4400
Mailing Address - Country:US
Mailing Address - Phone:540-941-3146
Mailing Address - Fax:540-941-3146
Practice Address - Street 1:501 OAK AVE
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:VA
Practice Address - Zip Code:22980-4400
Practice Address - Country:US
Practice Address - Phone:540-941-3146
Practice Address - Fax:540-941-3146
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-08
Last Update Date:2010-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202000973313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility