Provider Demographics
NPI:1679055990
Name:HALTOM, DEVIN PAIGE RILEY (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:DEVIN
Middle Name:PAIGE RILEY
Last Name:HALTOM
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:DEVIN
Other - Middle Name:PAIGE
Other - Last Name:RILEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:2140 BUFORD HWY STE 109
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30518-6121
Mailing Address - Country:US
Mailing Address - Phone:470-589-1742
Mailing Address - Fax:
Practice Address - Street 1:2140 BUFORD HWY STE 109
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30518-6121
Practice Address - Country:US
Practice Address - Phone:470-589-1742
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-04
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN46003406A235Z00000X
GASLP011365235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist