Provider Demographics
NPI:1619415890
Name:FERGUSON, ADRIANA (SLP)
Entity type:Individual
Prefix:
First Name:ADRIANA
Middle Name:
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3348 SKYLINE VIEW DR
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-5063
Mailing Address - Country:US
Mailing Address - Phone:775-223-1134
Mailing Address - Fax:
Practice Address - Street 1:1025 ROBERTA LN
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89431-1893
Practice Address - Country:US
Practice Address - Phone:775-825-4744
Practice Address - Fax:775-351-1644
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-07
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NESP-2086235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist