Individual
MS. TAMMY L VELLIQUETTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.ED. CCC SLP L
Contact information
Practice address
6732 SPRING ST, DOUGLASVILLE, GA 30134-1760
(404) 934-0605
(770) 577-2816
Mailing address
PO BOX 6336, DOUGLASVILLE, GA 30154-0023
(404) 934-0605
(770) 577-2816
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP004538
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00839781C
—
GA
01
—
01089131
ASHA
—
01
—
SLP004538
GEORGIA STATE LICENSE
GA
Enumeration date
11/06/2006
Last updated
01/03/2014
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