NPI | 1881063881 |
---|---|
Former Name | KATIE FAGERLAND |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: VA 2202008710) |
Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: NY 025739) |
Enumeration Date | 2015-09-20 |
Last Update Date | 2020-06-23 |