Provider Demographics
NPI:1033286687
Name:SHULMAN, VIRNA LISI (SLP)
Entity Type:Individual
Prefix:MRS
First Name:VIRNA
Middle Name:LISI
Last Name:SHULMAN
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 1:261 WHITE PINE WAY NW
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-5601
Mailing Address - Country:US
Mailing Address - Phone:678-354-8456
Mailing Address - Fax:
Practice Address - Street 1:2015 VAUGHN RD NW
Practice Address - Street 2:SUITE #130
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-7801
Practice Address - Country:US
Practice Address - Phone:770-425-6661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP6306235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist