Individual
LESLIE SUZANNE DETOTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CCC-SLP
Contact information
Practice address
200 S KIMBERLY RD, WARNER ROBINS, GA 31088-8721
(478) 293-4900
Mailing address
117 STEEPLECHASE RUN, WARNER ROBINS, GA 31088-2627
(478) 957-9003
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP003705
GA
Other
Enumeration date
03/11/2024
Last updated
03/11/2024
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