Individual
KUANTARA SHORELL INGRAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CCC-SLP
Contact information
Practice address
5373 THOMPSON MILL RD, HOSCHTON, GA 30548-4037
(770) 965-7003
Mailing address
3355 SWEETWATER RD APT 3202, LAWRENCEVILLE, GA 30044-8511
(334) 296-5421
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP011098
GA
Other
Enumeration date
07/24/2020
Last updated
07/24/2020
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