Provider Demographics
NPI:1912581083
Name:SEASHOLTZ, CIERA (MED, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CIERA
Middle Name:
Last Name:SEASHOLTZ
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:PO BOX 370
Mailing Address - Street 2:
Mailing Address - City:LAKE PARK
Mailing Address - State:GA
Mailing Address - Zip Code:31636-0370
Mailing Address - Country:US
Mailing Address - Phone:229-740-3072
Mailing Address - Fax:
Practice Address - Street 1:2151 EATONTON RD STE B
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:GA
Practice Address - Zip Code:30650-5088
Practice Address - Country:US
Practice Address - Phone:706-981-9314
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-05
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist