Provider Demographics
NPI:1801621008
Name:MCCARRON, ANGELICA RAE (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:ANGELICA
Middle Name:RAE
Last Name:MCCARRON
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 1:7651 TREMAYNE PL APT 108
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22102-7651
Mailing Address - Country:US
Mailing Address - Phone:505-306-3536
Mailing Address - Fax:
Practice Address - Street 1:803 W BROAD ST STE 100
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22046-3131
Practice Address - Country:US
Practice Address - Phone:571-378-1272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-06
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP11602235Z00000X
VA2202011603235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist