Doctor Name: | JESSIE NELSON WILLIS |
NPI Number: | 1265787485 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | CCC-SLP |
License Number: | 12148957 |
Business Practice Address: | 3203 Sutton Pl Duluth, GA - 300963515 |
Business Phone Number: | 4784548889 |
Business Fax Number: | |
Mailing Address: | 3203 Sutton Pl, DULUTH |
State: | GA |
Postal Code: | 300963515 |
Phone Number: | 4784548889 |
Fax Number: | |
NPI Enumeration Date: | 07/14/2012 |
NPI Last Update Date: | 08/13/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 12148957 |
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 |