Healthcare Provider Details

I. General information

NPI: 1649717653
Provider Name (Legal Business Name): CATHERINE ROSE HEAD CF-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2017
Last Update Date: 01/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8229 BOONE BLVD SUITE 660
VIENNA VA
22182-2623
US

IV. Provider business mailing address

105 PETTICOAT LN
ANNANDALE NJ
08801-2037
US

V. Phone/Fax

Practice location:
  • Phone: 703-821-1363
  • Fax:
Mailing address:
  • Phone: 908-255-2881
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: