Individual
LISA J EADY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M. ED. CCC
Contact information
Practice address
121B LEE ST, CARROLLTON, GA 30117-3314
(770) 830-8622
(770) 832-9031
Mailing address
121B LEE ST, CARROLLTON, GA 30117-3314
(770) 830-8622
(770) 832-9031
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP007179
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
184070266A
—
GA
Enumeration date
09/29/2009
Last updated
10/21/2009
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