Provider Demographics
NPI:1104177070
Name:MCFADDEN, ALICIA (MA, CCC-SLP, BCS-CL)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:MCFADDEN
Suffix:
Gender:F
Credentials:MA, CCC-SLP, BCS-CL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 ROSEMARY LN
Mailing Address - Street 2:
Mailing Address - City:PURCELLVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20132-3273
Mailing Address - Country:US
Mailing Address - Phone:301-752-2249
Mailing Address - Fax:
Practice Address - Street 1:44025 PIPELINE PLZ STE 105
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-5886
Practice Address - Country:US
Practice Address - Phone:301-752-2249
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-02
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20043235Z00000X
VA2202007325235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist