Provider Demographics
NPI:1376731745
Name:SEVENER, GALE ANN (SLP-MA CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:GALE
Middle Name:ANN
Last Name:SEVENER
Suffix:
Gender:F
Credentials:SLP-MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:173 STONYBROOK CT
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30605-4344
Mailing Address - Country:US
Mailing Address - Phone:706-549-6894
Mailing Address - Fax:706-549-6894
Practice Address - Street 1:173 STONYBROOK CT
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30605-4344
Practice Address - Country:US
Practice Address - Phone:706-549-6894
Practice Address - Fax:706-549-6894
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-10
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP003230235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00063773EMedicaid