| Organization Name: | SPEECH PATHOLOGY ASSOCIATES OF SOUTH EAST GEORGIA, PC |
| NPI Number: | 1083727325 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | SHANNON S BENNETT (OWNER) |
| Mailing Address: | 2976 Us Highway 84 Blackshear |
| State: | GA US |
| Postal Code: | 315164601 |
| Phone Number: | 9128078255 |
| Fax Number: | 9128078256 |
| NPI Enumeration Date: | 08/17/2006 |
| NPI Last Update Date: | 07/29/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | SLP003867 |
| 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 |