Provider Demographics
NPI:1255560033
Name:NOTARNICOLA, DEBRA SUE (MS, CCC/SLP)
Entity type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:SUE
Last Name:NOTARNICOLA
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 1:3985 ROLLING HILLS DR
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-9448
Mailing Address - Country:US
Mailing Address - Phone:678-455-8811
Mailing Address - Fax:678-455-8811
Practice Address - Street 1:3985 ROLLING HILLS DR
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-9448
Practice Address - Country:US
Practice Address - Phone:678-455-8811
Practice Address - Fax:678-455-8811
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-14
Last Update Date:2009-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP006305235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GASLP006305OtherGEORGIA SPEECH LANGUAGE PATHOLIGIST LICENSE