Provider Demographics
NPI:1245567692
Name:FOLSOM, BRITTANY T (SLP)
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:T
Last Name:FOLSOM
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 1:2700 N OAK ST
Mailing Address - Street 2:BLDG A
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-1772
Mailing Address - Country:US
Mailing Address - Phone:229-244-1667
Mailing Address - Fax:229-244-8253
Practice Address - Street 1:2700 N OAK ST
Practice Address - Street 2:BLDG A
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-1772
Practice Address - Country:US
Practice Address - Phone:229-244-1667
Practice Address - Fax:229-244-8253
Is Sole Proprietor?:No
Enumeration Date:2009-11-05
Last Update Date:2014-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP007209235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA433007451DMedicaid