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Individual

GABRIELLE FERGUSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
3888 LAVISTA RD, TUCKER, GA 30084-5142
(866) 991-0900
Mailing address
3888 LAVISTA RD, TUCKER, GA 30084-5142
(770) 938-5740

Taxonomy

Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
113232
TX
235Z00000X
Speech-Language Pathologist
Primary
SLP009191
GA

Other

Enumeration date
01/24/2017
Last updated
09/04/2019
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