Provider Demographics
NPI:1083874895
Name:NORMAN, OPAL JEAN M (GL SLP EDS)
Entity Type:Individual
Prefix:MRS
First Name:OPAL
Middle Name:JEAN M
Last Name:NORMAN
Suffix:
Gender:F
Credentials:GL SLP EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4969 OLD ADEL RD
Mailing Address - Street 2:
Mailing Address - City:MOULTRIE
Mailing Address - State:GA
Mailing Address - Zip Code:31788-1276
Mailing Address - Country:US
Mailing Address - Phone:229-985-3765
Mailing Address - Fax:
Practice Address - Street 1:4969 OLD ADEL RD
Practice Address - Street 2:
Practice Address - City:MOULTRIE
Practice Address - State:GA
Practice Address - Zip Code:31788-1276
Practice Address - Country:US
Practice Address - Phone:229-985-3765
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-16
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP000109235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist