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Individual
LISA QUATTLEBAUM
Active
Individual
LISA QUATTLEBAUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
SLP
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP006265
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
058600615
DRIVER'S LICENSE
GA
Enumeration date
04/24/2009
Last updated
04/24/2009
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