Provider Demographics
NPI:1184946345
Name:SANTUS, NINA MONIQUE (MS CCC/SLP)
Entity type:Individual
Prefix:MS
First Name:NINA
Middle Name:MONIQUE
Last Name:SANTUS
Suffix:
Gender:F
Credentials:MS CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:570 ADERHOLD HL
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30602-0001
Mailing Address - Country:US
Mailing Address - Phone:706-542-4561
Mailing Address - Fax:
Practice Address - Street 1:570 ADERHOLD HL
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30609-0001
Practice Address - Country:US
Practice Address - Phone:706-542-4561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-15
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA007804235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist