Provider Demographics
NPI:1588276224
Name:LONGSHORE, GEORGIA KATTERJOHN (CF-SLP)
Entity type:Individual
Prefix:
First Name:GEORGIA
Middle Name:KATTERJOHN
Last Name:LONGSHORE
Suffix:
Gender:F
Credentials:CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1920 14TH ST NW APT 305
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20009-3762
Mailing Address - Country:US
Mailing Address - Phone:334-558-3040
Mailing Address - Fax:
Practice Address - Street 1:201 MASS AVE NE STE C9
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-4988
Practice Address - Country:US
Practice Address - Phone:202-544-5469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist