Individual
MRS. STACEY LYN GOTHARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MED CCC-SLP
Contact information
Practice address
147 ALEXANDER LAKES DR, EATONTON, GA 31024-8051
(678) 469-8421
Mailing address
147 ALEXANDER LAKES DR, EATONTON, GA 31024-8051
(678) 469-8421
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP005346
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000961881B
—
GA
Enumeration date
01/05/2007
Last updated
08/14/2026
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