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General NPI Number Information
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NPI Number | 1235683160
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Entity Type | Individual
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Provider Name | KAYLA LIVESAY FERGUSON M.A., CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 08/09/2016
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Last Update Date | 12/30/2024
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Provider Practice Location Address
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Address Line | 4560 PRINCESS ANNE RD
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City | VIRGINIA BEACH
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State | VA
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Zip | 23462-7905
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Country | US
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Telephone | 757-495-4211
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Fax |
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Provider Business Mailing Address
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Address Line | 1376 STEPHENS RD
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City | VIRGINIA BEACH
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State | VA
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Zip | 23454-1538
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Country | US
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Telephone | 540-333-0854
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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