Basic Information
| Provider Information | |||||||||
| NPI: | 1558828046 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ESCHENFELDER | ||||||||
| FirstName: | DODRA | ||||||||
| MiddleName: | RENEE | ||||||||
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| Credential: | SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 222 KISSIMMEE TRAIL | ||||||||
| Address2: | |||||||||
| City: | CORNELIA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30531 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8645574740 | ||||||||
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| Practice Location | |||||||||
| Address1: | 104 BUILDERS PKWY STE B | ||||||||
| Address2: | |||||||||
| City: | CORNELIA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 305315397 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6786163099 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/21/2019 | ||||||||
| LastUpdateDate: | 02/21/2019 | ||||||||
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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 | SLP008712 | GA | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.