Doctor Name: | TERRY MARIE KLOCK |
NPI Number: | 1740243435 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | CCC-SLP |
License Number: | 4422 |
Business Practice Address: | 12191 Clipper Dr Lake Ridge, VA - 221922237 |
Business Phone Number: | 7034963486 |
Business Fax Number: | |
Mailing Address: | 4801 W Braddock Rd, Apartment 203 ALEXANDRIA |
State: | VA |
Postal Code: | 223114801 |
Phone Number: | 3015240718 |
Fax Number: | |
NPI Enumeration Date: | 04/11/2006 |
NPI Last Update Date: | 02/15/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 4422 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MD |
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 |