Provider Demographics
NPI:1831220227
Name:SOPT, MILLICENT ZIPPERER (MED, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:MILLICENT
Middle Name:ZIPPERER
Last Name:SOPT
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 1:300 PLANTATION DR
Mailing Address - Street 2:
Mailing Address - City:QUITMAN
Mailing Address - State:GA
Mailing Address - Zip Code:31643-3991
Mailing Address - Country:US
Mailing Address - Phone:229-263-4110
Mailing Address - Fax:
Practice Address - Street 1:903 N COURT ST
Practice Address - Street 2:
Practice Address - City:QUITMAN
Practice Address - State:GA
Practice Address - Zip Code:31643-1315
Practice Address - Country:US
Practice Address - Phone:229-263-6327
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP003979235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist