Doctor Name: | NICOLE ELIZABETH HERNDON |
NPI Number: | 1225493802 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | CCC-SLP |
License Number: | 2202007760 |
Business Practice Address: | 11150 Fairfax Blvd Suite 500 Fairfax, VA - 220305066 |
Business Phone Number: | 7035370373 |
Business Fax Number: | 7038657379 |
Mailing Address: | 11150 Fairfax Blvd, Suite 500 FAIRFAX |
State: | VA |
Postal Code: | 220305066 |
Phone Number: | 7035370373 |
Fax Number: | 7038657379 |
NPI Enumeration Date: | 12/23/2015 |
NPI Last Update Date: | 12/23/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 2202007760 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | VA |
Taxonomy Type: | Speech, Language and Hearing Service Providers |
Taxonomy Classification: | Speech-Language Pathologist |
Taxonomy Specialization: | |
Taxonomy Definition: | A speech pathologist is a person qualified by a master |