Doctor Name: | KELLY LEIGH VITUG |
NPI Number: | 1699025767 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MS CCC-SLP |
License Number: | SLP007702 |
Business Practice Address: | 3490 Joe Chandler Rd Gainesville, GA - 305077748 |
Business Phone Number: | 7705407253 |
Business Fax Number: | |
Mailing Address: | 3490 Joe Chandler Road, GAINESVILLE |
State: | GA |
Postal Code: | 30507 |
Phone Number: | 7705407253 |
Fax Number: | |
NPI Enumeration Date: | 09/14/2012 |
NPI Last Update Date: | 09/14/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | SLP007702 |
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 |