Provider Demographics
NPI:1629265202
Name:DESHONG, FELICIA (SLP)
Entity Type:Individual
Prefix:
First Name:FELICIA
Middle Name:
Last Name:DESHONG
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:966 SAMPLES LN NW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30318-4033
Mailing Address - Country:US
Mailing Address - Phone:404-713-3221
Mailing Address - Fax:404-794-7065
Practice Address - Street 1:966 SAMPLES LN NW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30318-4033
Practice Address - Country:US
Practice Address - Phone:404-713-3221
Practice Address - Fax:404-794-7065
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-27
Last Update Date:2007-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP006657235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist