Healthcare Provider Details

I. General information

NPI: 1093546368
Provider Name (Legal Business Name): KAILEY HEGEDUS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2024
Last Update Date: 08/09/2024
Certification Date: 08/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 DENFELD AVE
KENSINGTON MD
20895-1510
US

IV. Provider business mailing address

850 HUNGERFORD DR
ROCKVILLE MD
20850-1718
US

V. Phone/Fax

Practice location:
  • Phone: 240-740-0920
  • Fax:
Mailing address:
  • Phone: 240-740-5500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number11164
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: