Individual
MRS. STACEY LYN GOTHARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MED CCC-SLP
Contact information
Practice address
335 NICKLAUS CIR, SOCIAL CIRCLE, GA 30025-5344
(678) 625-4556
(678) 625-9638
Mailing address
335 NICKLAUS CIR, SOCIAL CIRCLE, GA 30025-5344
(678) 625-4556
(678) 625-9638
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP005346
GA
Other
Enumeration date
01/05/2007
Last updated
07/08/2007
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