Doctor Name: | KIMBERLY JAN TUCKER |
NPI Number: | 1336131994 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.ED., CFY-SLP |
License Number: | SLP00006300 |
Business Practice Address: | 3615 Braselton Hwy Suite 103 Dacula, GA - 300195907 |
Business Phone Number: | 6783779634 |
Business Fax Number: | 6783779609 |
Mailing Address: | 3615 Braselton Hwy, Suite 103 DACULA |
State: | GA |
Postal Code: | 300195907 |
Phone Number: | 6783779634 |
Fax Number: | 6783779609 |
NPI Enumeration Date: | 08/19/2005 |
NPI Last Update Date: | 07/09/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | SLP00006300 |
Healthcare Provider Taxonomy: (Secondary) | N |
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 |