Basic Information
| Provider Information | |||||||||
| NPI: | 1528285194 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ANTONELLI | ||||||||
| FirstName: | SETHLEY | ||||||||
| MiddleName: | BRANAN | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | M.S., CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2353 TALAMILL DR | ||||||||
| Address2: | |||||||||
| City: | MARIETTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300666472 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1441 CLIFTON RD NE | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303221004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4047125527 | ||||||||
| FaxNumber: | 4047125974 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/18/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 005805 | GA | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.