Provider Demographics
NPI:1902823552
Name:DENDY, EVITA C (SLP-CCC)
Entity Type:Individual
Prefix:
First Name:EVITA
Middle Name:C
Last Name:DENDY
Suffix:
Gender:F
Credentials:SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:768 WINBROOK DR
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-8037
Mailing Address - Country:US
Mailing Address - Phone:404-279-2650
Mailing Address - Fax:
Practice Address - Street 1:768 WINBROOK DR
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-8037
Practice Address - Country:US
Practice Address - Phone:404-279-2650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA006655235Z00000X
GAPCET001183235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist