Provider Demographics
NPI:1184840308
Name:BINGHAM, JANELLE ELOISE (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JANELLE
Middle Name:ELOISE
Last Name:BINGHAM
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1090 MONTCLAIR WAY
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-7323
Mailing Address - Country:US
Mailing Address - Phone:704-877-7710
Mailing Address - Fax:
Practice Address - Street 1:4535 FLAT SHOALS PKWY
Practice Address - Street 2:SUITE 301
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30034-5039
Practice Address - Country:US
Practice Address - Phone:704-877-7710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016472235Z00000X
NC7687235Z00000X
GASLP008593235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7412765Medicaid
NC146A7OtherBCBS