Provider Demographics
NPI:1114284353
Name:DALE, JEANNIE SHABABY (MS,CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JEANNIE
Middle Name:SHABABY
Last Name:DALE
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Gender:F
Credentials:MS,CCC-SLP
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Mailing Address - Street 1:545 OLD NORCROSS RD
Mailing Address - Street 2:STE 100
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-3389
Mailing Address - Country:US
Mailing Address - Phone:678-377-2833
Mailing Address - Fax:678-377-2882
Practice Address - Street 1:545 OLD NORCROSS RD
Practice Address - Street 2:STE 100
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-3389
Practice Address - Country:US
Practice Address - Phone:678-377-2833
Practice Address - Fax:678-377-2882
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-12
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GASLP007644235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist