Individual
LATICIA PECK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
SLP
Contact information
Practice address
1165 PINE LAKE DR, GRAYSON, GA 30017-7926
(678) 852-4022
(770) 972-5577
Mailing address
1165 PINE LAKE DR, GRAYSON, GA 30017-7926
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP005865
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
371442378F
—
GA
Enumeration date
01/05/2006
Last updated
04/28/2009
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