1639168974 NPI number — MRS. KARA LEIGH F. VESSEY M.S., CCC/SLP

Table of content: MRS. KARA LEIGH F. VESSEY M.S., CCC/SLP (NPI 1639168974)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639168974 NPI number — MRS. KARA LEIGH F. VESSEY M.S., CCC/SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VESSEY
Provider First Name:
KARA LEIGH
Provider Middle Name:
F.
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.S., CCC/SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1639168974
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/27/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
21000 EDUCATION CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROADLANDS
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
20148-5526
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
571-252-1000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
43329 HUDDLESTON LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTH RIDING
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
20152-1776
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
571-332-5108
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/19/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  2202003683 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)