Doctor Name: | MR. KENNETH ALLEN THISDALE |
NPI Number: | 1013901156 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.A., CCC-SLP |
License Number: | SLP003500 |
Business Practice Address: | 948 Wood Duck Ct Snellville, GA - 300787728 |
Business Phone Number: | 4049647808 |
Business Fax Number: | 7709822247 |
Mailing Address: | 948 Wood Duck Ct, SNELLVILLE |
State: | GA |
Postal Code: | 300787728 |
Phone Number: | 4049647808 |
Fax Number: | 7709822247 |
NPI Enumeration Date: | 09/06/2005 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | SLP003500 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | GA |
Taxonomy Type: | Speech, Language and Hearing Service Providers |
Taxonomy Classification: | Speech-Language Pathologist |
Taxonomy Specialization: | |
Taxonomy Definition: | A speech pathologist is a person qualified by a master |