Provider Demographics
NPI:1487016671
Name:SIMON, NATALIE ELLE (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:ELLE
Last Name:SIMON
Suffix:
Gender:F
Credentials: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 1:1295 E ROCK SPRINGS RD NE APT 307
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30306-2339
Mailing Address - Country:US
Mailing Address - Phone:248-635-4736
Mailing Address - Fax:
Practice Address - Street 1:1295 E ROCK SPRINGS RD NE APT 307
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30306-2339
Practice Address - Country:US
Practice Address - Phone:248-635-4736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-25
Last Update Date:2016-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP008905235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist