Basic Information
| Provider Information | |||||||||
| NPI: | 1922450949 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BARRETT | ||||||||
| FirstName: | THERESA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | M.ED., CCC/SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6036 WALDEN POND RD | ||||||||
| Address2: | |||||||||
| City: | GAINESVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 305062880 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7709830768 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 5226 DAHLONEGA HWY | ||||||||
| Address2: | |||||||||
| City: | CLERMONT | ||||||||
| State: | GA | ||||||||
| PostalCode: | 305271946 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6786163099 | ||||||||
| FaxNumber: | 7704066840 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/01/2016 | ||||||||
| LastUpdateDate: | 07/01/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | SLP001501 | GA | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.