Provider Demographics
NPI:1760819239
Name:SMALLS, SIERRA (CCCSLP)
Entity Type:Individual
Prefix:
First Name:SIERRA
Middle Name:
Last Name:SMALLS
Suffix:
Gender:F
Credentials:CCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4961 BUFORD HIGHWAY SUITE 201
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CHAMBLEE
Mailing Address - State:GA
Mailing Address - Zip Code:30341
Mailing Address - Country:US
Mailing Address - Phone:404-575-4000
Mailing Address - Fax:678-279-7370
Practice Address - Street 1:4961 BUFORD HIGHWAY SUITE 201
Practice Address - Street 2:SUITE 201
Practice Address - City:CHAMBLEE
Practice Address - State:GA
Practice Address - Zip Code:30341
Practice Address - Country:US
Practice Address - Phone:404-575-4000
Practice Address - Fax:678-279-7370
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-30
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP008190235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist