Individual
BEVERLY CONRAD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
12253 SEAFORD CT, LAKE RIDGE, VA 22192-2356
(425) 205-0220
Mailing address
12253 SEAFORD CT, LAKE RIDGE, VA 22192-2356
(425) 205-0220
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
2202001340
VA
Other
Enumeration date
08/03/2014
Last updated
08/03/2014
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