Provider Demographics
NPI:1386070787
Name:MCDERMOTT, JUSTINE (AUD)
Entity type:Individual
Prefix:DR
First Name:JUSTINE
Middle Name:
Last Name:MCDERMOTT
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3801 UNIVERSITY DR 300
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-2503
Mailing Address - Country:US
Mailing Address - Phone:703-383-8130
Mailing Address - Fax:703-383-7353
Practice Address - Street 1:8650 SUDLEY RD
Practice Address - Street 2:SUITE 209
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-4419
Practice Address - Country:US
Practice Address - Phone:703-369-0300
Practice Address - Fax:703-369-0017
Is Sole Proprietor?:No
Enumeration Date:2013-09-18
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2201001528231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA2201001528OtherVA STATE AUDIOLOGY LICENSE