Provider Demographics
NPI:1861042830
Name:COLE, GEORGEANNE ROWLAND (SLP)
Entity Type:Individual
Prefix:
First Name:GEORGEANNE
Middle Name:ROWLAND
Last Name:COLE
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8341
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:TN
Mailing Address - Zip Code:37615-0341
Mailing Address - Country:US
Mailing Address - Phone:423-384-3076
Mailing Address - Fax:
Practice Address - Street 1:340 E JACKSON ST
Practice Address - Street 2:
Practice Address - City:GATE CITY
Practice Address - State:VA
Practice Address - Zip Code:24251-3526
Practice Address - Country:US
Practice Address - Phone:276-386-6118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-12
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202000440235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0000001683OtherSTATE LICENSE
VA22020000440OtherSTATE LICENSE