Provider Demographics
NPI:1740036011
Name:NEAL, MONIQUE (CCC-SLP)
Entity type:Individual
Prefix:
First Name:MONIQUE
Middle Name:
Last Name:NEAL
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 STEPHENSON AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-5899
Mailing Address - Country:US
Mailing Address - Phone:912-712-3999
Mailing Address - Fax:912-438-6907
Practice Address - Street 1:130 STEPHENSON AVE STE 102
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-5899
Practice Address - Country:US
Practice Address - Phone:912-712-3999
Practice Address - Fax:912-438-6907
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-27
Last Update Date:2024-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP012961235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist