Individual
KATIE RACKLEY DECOUDRES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.ED., CCC-SLP
Contact information
Practice address
701 BAYTREE RD, SUITE C, VALDOSTA, GA 31602-2880
(229) 253-1009
(229) 253-1039
Mailing address
701 BAYTREE RD, SUITE C, VALDOSTA, GA 31602-2880
(229) 253-1009
(229) 253-1039
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP007048
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003136404A
—
GA
01
—
12153747
ASHA
GA
Enumeration date
07/29/2013
Last updated
09/25/2013
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