Provider Demographics
NPI:1023200797
Name:HEBRON, MILEKAH (MA CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MILEKAH
Middle Name:
Last Name:HEBRON
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12300 APACHE AVE APT 1510
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31419-2341
Mailing Address - Country:US
Mailing Address - Phone:912-844-2936
Mailing Address - Fax:
Practice Address - Street 1:12300 APACHE AVE APT 1510
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31419-2341
Practice Address - Country:US
Practice Address - Phone:912-844-2936
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-15
Last Update Date:2007-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP006087235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist