Healthcare Provider Details

I. General information

NPI: 1962003046
Provider Name (Legal Business Name): KATHLEEN TUREK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2020
Last Update Date: 10/15/2024
Certification Date: 10/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 UNIVERSITY DR
FAIRFAX VA
22030-2503
US

IV. Provider business mailing address

3801 UNIVERSITY DR
FAIRFAX VA
22030-2503
US

V. Phone/Fax

Practice location:
  • Phone: 703-383-8130
  • Fax:
Mailing address:
  • Phone: 703-383-8130
  • Fax: 703-383-7350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number147001772
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number2201001962
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: