Provider Demographics
NPI:1881063881
Name:URSEL, KATIE (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:URSEL
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:
Other - Last Name:FAGERLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:7001A LOISDALE RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22150-1904
Mailing Address - Country:US
Mailing Address - Phone:703-971-0602
Mailing Address - Fax:
Practice Address - Street 1:7001A LOISDALE RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22150-1904
Practice Address - Country:US
Practice Address - Phone:703-971-0602
Practice Address - Fax:703-971-0606
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-20
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025739235Z00000X
VA2202008710235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist