Provider Demographics
NPI:1669971198
Name:ANDERSON, DEANNA (MED, CCC-SLP)
Entity type:Individual
Prefix:
First Name:DEANNA
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MED, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5235 CONCORD DOWNS DR
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-1360
Mailing Address - Country:US
Mailing Address - Phone:419-345-8125
Mailing Address - Fax:
Practice Address - Street 1:2450 ATLANTA HWY STE 1001
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-1252
Practice Address - Country:US
Practice Address - Phone:678-644-0819
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-11
Last Update Date:2018-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP008492235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist