Provider Demographics
NPI:1740995695
Name:WORRELL, RYANE MIKENZIE (MA CFY-SLP)
Entity type:Individual
Prefix:
First Name:RYANE
Middle Name:MIKENZIE
Last Name:WORRELL
Suffix:
Gender:F
Credentials:MA CFY-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4808 SPRINGBROOK DR
Mailing Address - Street 2:
Mailing Address - City:HAHIRA
Mailing Address - State:GA
Mailing Address - Zip Code:31632-3102
Mailing Address - Country:US
Mailing Address - Phone:229-560-6944
Mailing Address - Fax:888-450-0379
Practice Address - Street 1:4808 SPRINGBROOK DR
Practice Address - Street 2:
Practice Address - City:HAHIRA
Practice Address - State:GA
Practice Address - Zip Code:31632-3102
Practice Address - Country:US
Practice Address - Phone:229-560-6944
Practice Address - Fax:888-450-0379
Is Sole Proprietor?:No
Enumeration Date:2023-01-16
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPCET003768235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist