Healthcare Provider Details

I. General information

NPI: 1770738924
Provider Name (Legal Business Name): DARLENA S. FERGUSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2008
Last Update Date: 12/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 MCCOY RD
HUNTINGTON WV
25701-4937
US

IV. Provider business mailing address

2001 MCCOY RD
HUNTINGTON WV
25701-4937
US

V. Phone/Fax

Practice location:
  • Phone: 304-529-6205
  • Fax:
Mailing address:
  • Phone: 304-529-6205
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number9514
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: