Healthcare Provider Details

I. General information

NPI: 1134044258
Provider Name (Legal Business Name): VERA WILLEMSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6354 WALKER LN STE 250
ALEXANDRIA VA
22310-3229
US

IV. Provider business mailing address

2455 MANDEVILLE LN APT 1036
ALEXANDRIA VA
22314-6147
US

V. Phone/Fax

Practice location:
  • Phone: 703-971-0602
  • Fax:
Mailing address:
  • Phone: 931-505-0281
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2204001864
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: