Provider Demographics
NPI:1578696985
Name:DUKES, PAULETTE (MCD, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:PAULETTE
Middle Name:
Last Name:DUKES
Suffix:
Gender:F
Credentials:MCD, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 RIVERBEND DR
Mailing Address - Street 2:
Mailing Address - City:LAGRANGE
Mailing Address - State:GA
Mailing Address - Zip Code:30240-8030
Mailing Address - Country:US
Mailing Address - Phone:706-882-6418
Mailing Address - Fax:706-884-4671
Practice Address - Street 1:107 RIVERBEND DR
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30240-8030
Practice Address - Country:US
Practice Address - Phone:706-882-6418
Practice Address - Fax:706-884-4671
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP004262235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA10033339Medicaid
GA334845Medicaid