Provider Demographics
NPI:1619021284
Name:STAPP, DAWN SAMPSON (M ED CCC-SLP)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:SAMPSON
Last Name:STAPP
Suffix:
Gender:F
Credentials:M ED CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 E JACKSON ST STE A
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31792-4788
Mailing Address - Country:US
Mailing Address - Phone:229-516-0938
Mailing Address - Fax:229-236-0364
Practice Address - Street 1:1100 E JACKSON ST STE A
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31792-4788
Practice Address - Country:US
Practice Address - Phone:229-516-0938
Practice Address - Fax:229-236-0364
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP004400235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist