Provider Demographics
NPI:1497389530
Name:RICKMAN, ANNE REED (MED, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:REED
Last Name:RICKMAN
Suffix:
Gender:F
Credentials:MED, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 RIDGECREST CIR
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:GA
Mailing Address - Zip Code:30525-4196
Mailing Address - Country:US
Mailing Address - Phone:706-782-6330
Mailing Address - Fax:
Practice Address - Street 1:165 RIDGECREST CIR
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:GA
Practice Address - Zip Code:30525-4196
Practice Address - Country:US
Practice Address - Phone:706-782-6330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-27
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP001074235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist