Individual
ALEXANDRA RIDDICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1071 THOMAS AVE, WATKINSVILLE, GA 30677-6073
(770) 207-6390
Mailing address
1071 THOMAS AVE, WATKINSVILLE, GA 30677-6073
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP011198
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
SLP011198
PROFESSIONAL LICENSE
—
Enumeration date
06/17/2021
Last updated
06/17/2021
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