Provider Demographics
NPI:1063884229
Name:HURST, KATE ALLISON (CCC-SLP)
Entity type:Individual
Prefix:
First Name:KATE
Middle Name:ALLISON
Last Name:HURST
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4530 WALNEY ROAD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:CHANTILLY
Mailing Address - State:VA
Mailing Address - Zip Code:20151
Mailing Address - Country:US
Mailing Address - Phone:703-466-5533
Mailing Address - Fax:703-466-5316
Practice Address - Street 1:4530 WALNEY ROAD
Practice Address - Street 2:SUITE 203
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20151
Practice Address - Country:US
Practice Address - Phone:703-466-5533
Practice Address - Fax:703-466-5316
Is Sole Proprietor?:No
Enumeration Date:2015-10-28
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202002127235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist