Provider Demographics
NPI:1508059452
Name:SCHULTZ, ALISA NORRIS (MED, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:ALISA
Middle Name:NORRIS
Last Name:SCHULTZ
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 1:110 CARLTON ST
Mailing Address - Street 2:UGA SPEECH & HEARING CLINIC
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30602-5004
Mailing Address - Country:US
Mailing Address - Phone:706-542-4598
Mailing Address - Fax:
Practice Address - Street 1:110 CARLTON ST
Practice Address - Street 2:UGA SPEECH & HEARING CLINIC
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30602-5004
Practice Address - Country:US
Practice Address - Phone:706-542-4598
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-23
Last Update Date:2009-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP005544235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist