| Doctor Name: | KELLY FERGUSON |
| NPI Number: | 1407073331 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 2202005179 |
| Business Practice Address: | 4560 South Blvd Virginia Beach, VA - 234521160 |
| Business Phone Number: | 7574903223 |
| Business Fax Number: | |
| Mailing Address: | 5903 Willow Oaks Dr, RICHMOND |
| State: | VA |
| Postal Code: | 232252432 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 04/20/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | 2202005179 |
| 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 |