Provider Demographics
NPI:1063533693
Name:EID, KATRINA N (PHD CCC-SLP)
Entity type:Individual
Prefix:DR
First Name:KATRINA
Middle Name:N
Last Name:EID
Suffix:
Gender:F
Credentials:PHD CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1308 ROSS DR SW
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22180
Mailing Address - Country:US
Mailing Address - Phone:703-258-2564
Mailing Address - Fax:
Practice Address - Street 1:1308 ROSS DR SW
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22180-6724
Practice Address - Country:US
Practice Address - Phone:703-258-2564
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202001187235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist