Provider Demographics
NPI:1932224854
Name:LIU, JIA (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JIA
Middle Name:
Last Name:LIU
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3225 MUNSEY CT
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-9313
Mailing Address - Country:US
Mailing Address - Phone:205-799-5003
Mailing Address - Fax:
Practice Address - Street 1:1502 MAIN ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:AL
Practice Address - Zip Code:36744-1552
Practice Address - Country:US
Practice Address - Phone:205-575-1609
Practice Address - Fax:334-624-3960
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2016-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1729235Z00000X
MS2894235Z00000X
GASLP008215235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL890016790Medicaid
AL146617Medicaid
AL890016790Medicaid