Provider Demographics
NPI:1780037325
Name:REID, DENIQUE
Entity Type:Individual
Prefix:
First Name:DENIQUE
Middle Name:
Last Name:REID
Suffix:
Gender:F
Credentials:
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 HWY
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CHAMBLEE
Mailing Address - State:GA
Mailing Address - Zip Code:30341-3535
Mailing Address - Country:US
Mailing Address - Phone:404-575-4000
Mailing Address - Fax:
Practice Address - Street 1:4961 BUFORD HWY
Practice Address - Street 2:SUITE 201
Practice Address - City:CHAMBLEE
Practice Address - State:GA
Practice Address - Zip Code:30341-3535
Practice Address - Country:US
Practice Address - Phone:404-575-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-19
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP009340235Z00000X
TX113264235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist