Provider Demographics
NPI:1790923720
Name:HARRELL, DENISE (MED CCC-SLP)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:HARRELL
Suffix:
Gender:F
Credentials:MED CCC-SLP
Other - Prefix:
Other - First Name:DENISE
Other - Middle Name:
Other - Last Name:FLANDERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED CCC-SLP
Mailing Address - Street 1:59 TRIXIE ST
Mailing Address - Street 2:
Mailing Address - City:RAY CITY
Mailing Address - State:GA
Mailing Address - Zip Code:31645-8607
Mailing Address - Country:US
Mailing Address - Phone:229-251-0968
Mailing Address - Fax:
Practice Address - Street 1:193 TRIXIE ST
Practice Address - Street 2:
Practice Address - City:RAY CITY
Practice Address - State:GA
Practice Address - Zip Code:31645-8612
Practice Address - Country:US
Practice Address - Phone:229-251-0968
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-29
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPCET001403235Z00000X
GASLP007198235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist