Healthcare Provider Details

I. General information

NPI: 1679247761
Provider Name (Legal Business Name): KAREN UBER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2021
Last Update Date: 08/03/2021
Certification Date: 08/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 STAFFORD AVE
STAFFORD VA
22554-7246
US

IV. Provider business mailing address

1 SUNSET RIDGE LN
FREDERICKSBURG VA
22405-5784
US

V. Phone/Fax

Practice location:
  • Phone: 540-658-6000
  • Fax:
Mailing address:
  • Phone: 540-658-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2203000567
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: