Doctor Name: | RANDI POMYCALA |
NPI Number: | 1760855894 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MS, CCC-SLP |
License Number: | SLP008668 |
Business Practice Address: | 3950 Austell Rd Austell, GA - 301061121 |
Business Phone Number: | 7703724000 |
Business Fax Number: | |
Mailing Address: | 3950 Austell Rd, AUSTELL |
State: | GA |
Postal Code: | 301061121 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 11/11/2015 |
NPI Last Update Date: | 03/11/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | SLP008668 |
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 |