Individual
MR. KENNETH ALLEN THISDALE
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
M.A., CCC-SLP
Contact information
Practice address
948 WOOD DUCK CT, SNELLVILLE, GA 30078-7728
(404) 964-7808
(770) 982-2247
Mailing address
948 WOOD DUCK CT, SNELLVILLE, GA 30078-7728
(404) 964-7808
(770) 982-2247
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP003500
GA
Other
Enumeration date
09/06/2005
Last updated
07/08/2007
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