Facts
- Status
- A
- Credential
- SLP
- Type
- Individual
- Enumeration date
- 2006-11-29
- Last updated
- 2007-07-09
Specialties
Licenses
- License GA
- SLP001980
Location
- Practice location
- 1416 WEYERHAEUSER RD
- City
- LYONS GA
- Postal code
- 304362608
- Phone
- 912-526-6732
Medicare
- PECOS
- No PECOS enrollment row matched this NPI.
LEIE
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Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.