Provider Demographics
NPI:1235627613
Name:KOHL, ALEXANDRIA GINNY (SLP)
Entity Type:Individual
Prefix:
First Name:ALEXANDRIA
Middle Name:GINNY
Last Name:KOHL
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 1:225 WES PARK DR
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:GA
Mailing Address - Zip Code:31069-4829
Mailing Address - Country:US
Mailing Address - Phone:478-987-1610
Mailing Address - Fax:973-965-4580
Practice Address - Street 1:2225 BEMISS RD STE D
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-4819
Practice Address - Country:US
Practice Address - Phone:478-987-1610
Practice Address - Fax:973-965-4580
Is Sole Proprietor?:No
Enumeration Date:2018-05-01
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP010076235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist