NPI | 1972051951 |
---|---|
Former Name | LOGAN TINGLER |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: GA SLP010017) |
Additional Taxonomies | 235Z00000X Speech-Language Pathologist, (Licence: SC 6125) |
Enumeration Date | 2016-09-19 |
Last Update Date | 2019-02-22 |