Individual
KATHLEEN EGAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CCC-SLP, BCBA
Contact information
Practice address
11551 IVY BUSH CT, RESTON, VA 20191-2253
(571) 216-6945
Mailing address
11551 IVY BUSH CT, RESTON, VA 20191-2253
(571) 216-6945
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
0133000724
VA
235Z00000X
Speech-Language Pathologist
Primary
2202004421
VA
Other
Enumeration date
05/18/2016
Last updated
05/18/2016
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