Provider Demographics
NPI:1659975464
Name:SEALE, KERI ANN (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KERI
Middle Name:ANN
Last Name:SEALE
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 PLEASANT GROVE CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:VILLA RICA
Mailing Address - State:GA
Mailing Address - Zip Code:30180-4723
Mailing Address - Country:US
Mailing Address - Phone:985-231-8659
Mailing Address - Fax:
Practice Address - Street 1:4605 TIMBER RIDGE DR
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-1224
Practice Address - Country:US
Practice Address - Phone:770-947-0252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-23
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA7565235Z00000X
GASLP011315235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist