Individual
DEECIE MANN WILBANKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSP, CCC-SLP
Contact information
Practice address
416 LAKE FOREST DR, NEWNAN, GA 30265-3373
(803) 360-4589
Mailing address
416 LAKE FOREST DR, NEWNAN, GA 30265-3373
(803) 360-4589
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP008038
GA
Other
Enumeration date
11/06/2012
Last updated
11/06/2012
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