Provider Demographics
NPI:1881209138
Name:EARGLE, ALLISON ANASTASIA (MCD, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:ALLISON
Middle Name:ANASTASIA
Last Name:EARGLE
Suffix:
Gender:F
Credentials:MCD, CCC-SLP
Other - Prefix:MS
Other - First Name:ALLISON
Other - Middle Name:ANASTASIA
Other - Last Name:COTTILLION
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1011 PROFESSIONAL BLVD
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720-2506
Mailing Address - Country:US
Mailing Address - Phone:706-226-4623
Mailing Address - Fax:
Practice Address - Street 1:1011 PROFESSIONAL BLVD
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-2506
Practice Address - Country:US
Practice Address - Phone:706-226-4623
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-14
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist